Definition History CH interventions(Uganda) Evidence Updated Policies and Operational Guidelines VHT good practices VHT Impact Challenges

and constraints Improving Linkages with Health System Opportunities and Actions for Impact An example

A process which people are enabled to become actively involved in defining the issues of concern to them, in making decisions about factors that affect their lives and taking action to achieve change.

1978 Alma Ata declaration Community Based Health Care 1979 District Community Based Health Care Committees 2001- Village Health Committees 2002-Village Health Teams cooexisting with diverse community health actors 2009 Ouaga Dougou Declaration 2009 Update of VHT strategy and development of operational guidelines for all levels Clear Guidance for All Community Health Interventions to be implemented via VHT

Formation of VHT National Coordinating Committee Strengthening of former VHT Secretariat Now Known as VHT Steering Committee with addition of Key M o H Program Managers Formation of VHT Stakeholders Forum Draft Strategy (update) Draft Operational Guidelines 2 Members of Staff from HP and Environmental Health dedicated to VHTS

Coordination mechanisms Numbers of VHTs Standard Motivation Package Selection Criteria for VHTs Basic Functions refined

Coordination roles and functions defined for all levels All Community Health Activities via VHT Requirement for Joint Planning, Review and Reporting Recommendation Resource Pooling Coordination via DHMT DMO

Must be selected by the community itself and not imposed by political structures Should be exemplary, honest and trustworthy and respected Want to serve as a volunteer Must be a resident of the village Should be available to perform specified VHT tasks Should be interested in health and development matters Should be a good mobiliser and communicator May already be a CHW TBA, drug distributor or similar Ideally should be able to read and write at least the local language Political leaders cannot be selected Selection should be gender sensitive

Basic requirements to carry out VHT function

(Standardised VHT uniform, ID, Standardised bag and kit using MoH VHT logo. Lunch and travel allowance whilst carrying out outreach and visits to health centre). Health worker supervision and mentoring technical support Activity and performance related incentives Recognition by Authorities and their own communitiesAdvocacy and support for VHT to access Government programs, income generating schemes and other microfinance and credit schemes Community reward such as community digging, seeds, livestock

VHT BASIC FUNCTIONS Community Information management,

Health Promotion and Education Mobilization of communities for utilization of health services and health action Simple community case management and follow up of major killer diseases (Malaria, Diarrhoea, Pneumonia) and emergencies Care of the newborn Distribution of health commodities

Immunisation Provision of supplemental vitamin A children 6-59 months of age and postpartum mothers Provision of preventive zinc supplements to all children 6-59 months of age Promotion of breastfeeding immediately after birth, exclusive breastfeeding during the first 6 months of life, and continued after 6 months of age

Promotion of appropriate complementary feeding from 6 months Promotion of hygiene ( hand-washing), safe water, and sanitation Promotion of oral rehydration therapy (ORT) and zinc for children with diarrhoea Promotion of clean delivery Community-based treatment of childhood pneumonia Home-based neonatal care, which includes promotion of immediate and exclusive breastfeeding, promotion of cleanliness, prevention of hypothermia, and diagnosis and treatment of neonatal sepsis

Community-based rehabilitation of children with protein-calorie malnutrition via food supplementation (including rehabilitation of children with severe acute malnutrition by provision of ready-to-use dry therapeutic foods) Insecticide-treated bednets (ITNs) in malariaendemic areas Indoor residual spraying in malaria-endemic areas Community-based treatment of malaria Intermittent preventive treatment during pregnancy (IPTp) of malaria in malaria-endemic areas

Health Promotion Mobilisation Outbreak control and surveillance Nutritional surveillance and monitoring Distribution of commodities and drugs Community Information Management/Documentation Calculate coverage increases and lives saved

Tororo - Pit latrine coverage increased from 64% in 2003/4 to 85% in 2008/9 community mobilisation and sensitisation by VHTs Isingiro VHT/CHWs of the Millennium Villages Project (MVP) through community sensitisation and education increased health facility delivery from 12-15% to over 80% Mpigi Unusual Deaths identified by one VHT who had details of ALL (list of all names and ages addresses dates) facilitating outbreak investigation and cause from contaminated alcohol to be identified Mbarara CORPS/VHT Interventions from Jan 2006 to Feb 2009 has contributed to child mortality rate decline of 37%. Apac - 93% coverage IRS by VHTs, as a result, Malaria OPD attendance reduced from 78% to 53%

Empowering DHMT to coordinate partners Building the necessary linkages ( VHTCommunity-Health Centres, Cross Sectoral) Ensuring Necessary requirements for implementation (Learning from past experience with Homopak) Health Workers reinforcing messages and being a good example to community Failure to deliver minimum referral services by HCs Integration of established CHWs into VHT

Use Evidence and prioritise activities and interventions based on epidemiology and community perceptions of need Linking VHTs: Establish and maintain Necessary linkages with formal health system 1. With nearest Health Centre 2. With outreach activities 3. With other community structures and players Acknowledge good performance and impact Document actions collate data and show impact

Good Organisation VHTs Linked to nearest HC List on wall Register of VHTs Roster for individual VHT once per month enabling supervision/ supplies/ on job training mentoring Health centre or out reach VHT stay and assist queues/ registering/ weighing /Muac/OP ANC Nutritional clinics / Health education talks etc Empowering, Motivation builds good relationship and increases knowledge and skills and frees up HW to treat sick Monthly and quarterly meetings Competitions and prizes Radio programs

Mbarara linkage between ALL health training schools including laboratory and communities via VHT/CORP Makerere linkages Medical School and Community and School of Public Health Yumbe - Clean Village and best VHTcompetitions were organised and through health promotion talks by VHTs, cleanest village won a plaque plus a borehole (CAO); VHTs are given priority for functional adult literacy FAL classes; Linkages agriculture and forestry tree planting

 When

do we carry out post natal check for Mother? For newborn?

 Home

visits Referral for danger signs

Need good linkages Not enough to improve community and knowledge if not matched with minimum standards at Health Centre Need health workers Presence, Knowledge Skills and Basic Equipment/Drugs to have Impact Why PNC When PNC What PNC

If these in place then maximal impact possible (decrease of up to 79% in early neonatal mortality) WHO and UNICEF recommend that care be provided by a skilled attendant during and immediately after birth irrespective of where the birth takes place. Women who give birth in a health facility and their newborns should be assessed for problems and given a specific date to return for further postnatal care, even if everything is going well, and advised to return immediately if any danger Signs

The recommendation for women who give

birth at home without skilled care, and where continuous professional care cannot be assured, is that they should seek postnatal care as soon as possible after birth Postnatal home care by community health workers (VHTs) should be linked to the health system and the full continuum of care. Health services should try to bring postnatal care as close as possible to the home and the family. Gaps in services including skilled attendance at birth and treatment of newborn illness need to be addressed as part of a programmatic approach.

kuhitsya to 30/4/2009
Omuruka Parish_________________ Ekyaro Village_____________________ Date Ebiro byokwezi____ /____ /_____ Abahereza: CORPs _______________________Na and_________________________Na and____________________ Ebikozirwe Activity Home visits made Mutayayire amaka angahi? How many Health talks Emishomo yoona eyebyamagara eyimushomeise? Ebiro byokuzarwa Date Number Omuhendo gwebikozirwe

Live birth Abaana abazairwe bahureire nibangahi?

Eiziina ryanyineka Head of the household

Hospital Omwirwariro

Other Ahandi

Abaana abafiire kuruga aha mwaana owazarwa kuhika ahawemyaka etano nibangahi? Deaths from birth to five years

Emyaka eyiyaferireho years that death occured

Eiziina ryanyineka Head of the household

Hospital Omwirwariro

Other Ahandi

Abaa na abazirwe bafiire nibangahi? Omwaana owazarwa atarireho, atitsye nakakye nari atehindwire still birth

Ebiro byokuzarwa birth date

Neiziina ryanyineka Head of the household

Hospital Omwirwariro

Other Ahandi