Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
Community perceptions and participation in health in the context of the community health strategy in kenya
1. Community perceptions and participation in health in the
context of the Community Health Strategy in Kenya
Nelly Muturi1, Maryline Mireku1, Robinson Karuga1, Kelvin Ngugi1, Geoffrey Ombui1, Rosalind McCollum2,
Miriam Taegtmeyer2 and Lilian Otiso1
1Research and Strategic Information Department, LVCT Health, Nairobi, Kenya
2Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
Nelly Muturi
LVCT HEALTH, Kenya
23rd Feb 2017
1CHWSymposiumKampala_Nelly
2. Community
Participation (CP)
“the process by which individuals and families assume responsibility for
their own health and welfare and for those of the community, and develop
the capacity to contribute to their and the community’s development.”
The Alma Ata declaration, 1978
2
3. Background
• Community participation (CP) is key in
strengthening and sustaining health
systems
• CP;
– Improves accountability
– Improves equity
– Improves health service delivery and uptake
of services
• The Community Health Strategy (CHS)
in Kenya founded on community
participation
3
Photo by Nelly Muturi
4. CP in Health in
Kenya
4
Facility Health Management Committee
CHC Meetings Dialogue days Action days
5. Aim
1. Assess occurrence of
community meetings
2. Determine facilitators of
community participation
3. Determine the barriers of
community participation
5
Photo by Robinson Karuga
6. Study Design
Exploratory study design
Study sites
4 Community Health units
Sample selection
Purposive (Community
members, CHVs, CHEWS, CHC
members and Supervisors of
CHEWS)
Data collection
In depth interviews
FGDs
Methods
6
7. Key findings
CHC Meetings
• Not happening monthly
• CHEW not always a
member or rarely
present
• CHCs non-existent in
some areas
7
“First and foremost actually I
would say we are ill equipped
some of my members don’t
even know their roles in the
CHC because we have never
had any formal training.” CHC
member
8. Key findings
Dialogue days
•Not happening quarterly
•Not well represented by stakeholders
•Not informed by community data- Did
not always lead to an Action day
•Attendance from community leaders
was a facilitator
–Chief barazas utilized as a forum for CP in health
•Lack of budgetary support
8
“”You know most of the
meetings people attend
to in the community have
been organized by the
chief and that’s a good
forum for CHW to explain
to the civilians as there’s
a quorum.” Male
community member
9. Key findings
Action days
• Most frequently reported
form of CP- little costs
involved
• Not informed by Dialogue
days
• Lack of community
support- least supported
– Attendance pegged on
incentives
9
“… It is difficult for one to
volunteer and then go buy
gumboots, gloves, only a
few have them.”
Community member
“During the
action day
the
committee
members
come maybe
two of them
and we team
up with
them.” CHV
10. Conclusion and
Recommendations
• There is need for regular monitoring of CP
to address gaps between policy and
practice
• Community members should be sensitized
on their crucial role in implementation of
CHS
• Budgetary allocation needs to be
considered for effective implementation of
CP e.g.
– Training of CHC members
– PA system, meeting venue
10
Photo by James Mboloi
11. 11
Nelly M. Muturi
Research Officer; LVCT Health
nmuturi@lvcthealth.org
@nellymuturi
www.lvcthealth.org
www.reachoutconsortium.org
REACHOUT is funded by the European Union Seventh
Framework Programme ([FP7/2007-2013] [FP7/2007-
2011]) under grant agreement n° 306090
Notes de l'éditeur
Remember to introduce yourself
CHS forms Tier 1 level of service delivery; there are 4 tiers in the Kenya Health System
Comprised of the Community Health Unit (CHU) (equivalent to a location); comprised of CHVs; community health volunteers; approximately 50 CHVs who are supervised by the Community Health Extension Workers (CHEWS) in each CHU.
CHVs offer basic health services including; referral services, health education/promotion, community mobilization the context of health e.g. health campaigns
CHS forms Tier 1 level of service delivery; there are 4 tiers in the Kenya Health System
Comprised of the Community Health Unit (CHU) (equivalent to a location); comprised of CHVs; community health volunteers; approximately 50 CHVs who are supervised by the Community Health Extension Workers (CHEWS) in each CHU.
CHVs; who are selected community members, selected by the community and offer basic health services including; referral services, health education/promotion, community mobilization the context of health e.g. health campaigns
CP at community level; facilitates greater policy responsiveness to community needs ,contributing to the system’s effectiveness and sustainability by providing feedback and securing involvement in collective decision making [12]; this consequently improves/promotes accountability to HSPs and the government as a whole
Incorporation of public views into priority setting is perceived as a means to
restore trust, improve accountability, and secure cost-effective priorities within healthcare.
Dialogue days- This is a feedback meeting between the community members, link facility staff, CHVs and CHEWS. During these meetings; the stakeholders give feedback to each other on the health status of the community, uptake of health services.
During these meetings the MOH 316 (Chalkboard) is used to provide community health data that is interrogated and community members given feedback.
Dialogue days are convened by Community Health Committee (CHC) members; which is the governance structure of the CU (who include the CHEW- Secretary)
CHVs mobilize community members to attend dialogue days
Action Days- Just as the name sounds, this a day set aside by the stakeholders (who attended the dialogue day) to address a common problem in the community unit. This include; a cleaning exercise, health education activity etc.
Community Health Committee (CHC)- The CHC is the governance structure of the community unit. Comprised of selected members of the community; respected community members/ leaders, representative from the local administration.
Facility Health Management Committee- Includes membership from the link facility (HSPs) and selected community members who include a CHC member; depending on the level of the facility a CHEW is a member e.g. CHEW
The main aim of this study was to determine the differences in policy and practice for community participation through community meetings in CHS in 4 selected CHUs in Kenya
Study design; This was an exploratory study; conducted between 2013- 2015
Study sites; The study was conducted in 4 community units within 2 Counties of Kenya; 2 Rural, 2 Peri-urban
Study participants: Study participants were Community members, CHVs, CHEWs, key informants who included members of the local administration and policy makers
Purposive sampling was conducted on all participants; FGDs conducted on community members while IDIs conducted on other respondents to capture data on enablers and facilitators of CP in the contest of CHS, Frequency and occurrence of community meetings, facilitation of community meetings.
Study respondents identified chief barazas, action days and dialogue days as forums through which the community members met and interacted with the CTC providers.
Action days were most frequently reported compared to dialogue days and CHC meetings
Action days only involved cleaning activities
These meetings were mainly ad hoc; and their composition was not necessarily guided by strategy
Some respondents considered household visits as a form of community meetings; other forums included church meetings and women group meetings where CHVs gave health talks
Chief/Sub-Chief; local administration support; This was either through their role in facilitation of community health meetings, including an agenda on community health during barazas and introducing CHVs to community members.
Study respondents identified chief barazas, action days and dialogue days as forums through which the community members met and interacted with the CTC providers.
Action days were most frequently reported compared to dialogue days and CHC meetings
Action days only involved cleaning activities
These meetings were mainly ad hoc; and their composition was not necessarily guided by strategy
Some respondents considered household visits as a form of community meetings; other forums included church meetings and women group meetings where CHVs gave health talks
Chief/Sub-Chief; local administration support; This was either through their role in facilitation of community health meetings, including an agenda on community health during barazas and introducing CHVs to community members.
Study respondents identified chief barazas, action days and dialogue days as forums through which the community members met and interacted with the CTC providers.
Action days were most frequently reported compared to dialogue days and CHC meetings
Action days only involved cleaning activities
These meetings were mainly ad hoc; and their composition was not necessarily guided by strategy
Some respondents considered household visits as a form of community meetings; other forums included church meetings and women group meetings where CHVs gave health talks
Chief/Sub-Chief; local administration support; This was either through their role in facilitation of community health meetings, including an agenda on community health during barazas and introducing CHVs to community members.
