Description of Technical Approach To improve community involvement in the programs for better outcomes,
AARDO in consultation propose the following strategies
: 1. Capacity building of NGO/health facility staff in community mobilization
2. Widening community involvement in the formation of HF and HP Shuras
3. Capacity building of HF and HP Shuras in community mobilization and leadership 4. Strengthening the link between HF and HP Shuras
1. Capacity building of NGO/health facility staff in community mobilization Afghan Australian Rehabilitation and Development Organization proposes to use its existing community mobilization training tools developed under the Health Services Support to train NGO and health facility staff. The training for NGO/ health facility staff will be of five days duration. involved in community mobilization activities. It will particularly train the In-charge of the health facility; CHS; AHDS CHW trainers, CBHC officer and health facility supervisor of project area. Relevant staff from AARDO will also attend this training. In this training, participants will understand Afghan health system, reasons for involving communities in health programs, community mobilization its importance and ways, community participation in health programs, building trust in communities, prioritization to health issues, plan development, local resource mobilization, assessment of health council capacities, potential conflicts during community mobilization and their solutions.
2. Widening community involvement in the formation of HF and HP Shuras A. Health Post Shuras As per the CBHC policy, each Health Post (HP) Shura has 6-9 members. Currently, in some villages, HP Shuras do not exist. Even where HP Shuras exist, many of their members are not active; hence, they are not fully functional. Considering this, we will either form the new HP Shura or reorganize the existing HP Shura. AARDO will initially form all male Shuras, unless there is support from the community to include female members. While female members would be a vital asset, the current very conservative practices mean that including women is not be feasible. It is hoped that over the course of the program period that women may be included in the HP and HF Shuras. If Health Post Shura does not exist:
I. Form HP Shura with CDC support: Formation of Community Development Councils (CDCs) under the National Solidarity Program (NSP) ensures wider community involvement as well as representation, particularly marginalized groups such as poor and ethnic minorities. Therefore, it would be useful to enter the communities through the CDCs and also involve them in the formation of health Shuras. This would not only ensure wider community involvement, it would also help in better acceptance of the health Shuras by the communities. In addition, communities will accept the ownership of HP Shuras, resulting in better support and participation in HP Shura activities. Under this intervention we will involve the CDC in identification and selection of HP Shura members.
II. Include members from CDC: In order to establish a link of HP Shura with wider community and closer working relationship with the CDC, the CHS will ensure that members of HP Shura are the members of CDC. As the CDC members have been selected using a fair election process, involving the entire community, including some CDC members as HP Shura members will ensure wider community representation.
III. Expand community representation: Remaining members will include other community representatives, particularly, Mullah, teacher, representative from School Management Committee (SMC if present), Public Private Facilities (PPF) staff (if present) and CHW.
- Provide capacity building and oversight of Shure-e-sehie as a forum to back up CHWs and strengthen community-facility linkages; (e.g. for referral, outreach activities, and priority setting)
- Promote facility/community shura coordination and collaboration with Community Development Councils (CDCs) to address health problems in communities.
- Introduce evidence-based and culturally sensitive behaviour change strategies so that men and women actively participate in community health activities and contribute to changing social norms.
- Scale up Family Health Action Groups (FHAs) to the national level to support community health workers (especially the female CHWs)
- Monitor and supervise the performance of workers at health posts and facilities using quality improvement approaches and promote expansion of those that prove effective Continually train CHWs in order to enhance and maintain core competencies, skills and changes of attitude
- Promote the design and testing of innovative and effective ways in which community midwives and nurses at health facilities can work collaboratively with CHWs Strengthen and implement a compensation and recognition mechanism for all CHWs so they are adequately compensated for their work and their expenses
- Collect best practices from health programs and services through regular sessions with staff and clients that identify and document “what is working well?; what concerns or gaps are there? What suggestions would you offer to improve the program or service?”
- Discuss the need for adding new indicators for health promotion (e.g. for Behaviour Change Communication [BCC]) to routine HMIS data collection and population surveys
Behaviour change and information, education and communication strategies are an element of each of the strategic components described in this strategy document. Hence IEC/BCC is a cross-cutting issue of extreme importance in RH. Nevertheless, the existing situation falls short of the ideal, and serious challenges confront RH authorities in attempting to improve the situation:
Health system lacks a standard package of IEC materials on RH;
- Health providers lack interpersonal communication and counselling (IPCC) skills;
- IPCC is a long term intervention—it needs a long term engagement and follow up to improve it;IEC materials are not properly used.
Strengthening IEC materials production, distribution and use
Development of a standard package of RH IEC materials. All IEC materials produced for RH will be collated, reviewed, standardised and made available to implementing partners and RH organizations within the private sector.
List of all RH IEC materials to be included on national M&E checklist.
Develop a distribution and monitoring mechanism for RH IEC materials in health facilities to track availability, utilization and replacement of RH IEC materials.