| Element One: Frequently Asked Questions:
What are the underlying assumptions for Element 1?
- Facilities exist and are functional
- Communities have geographic and economic access to facilities
- Ideally, health workers are trained in IMCI systems, improvements are in place, and quality of care meets standards
Where is Element 1 crucial?
- Facilities and services have been improved, but utilization of child health services is still less than expected
- CHWs are linked to health facilities
- MOH or other organization has limited experience with community work
How does Element 1 differ from other community programs?
- Linkages are made to implementation of IMCI in facilities
- Facilities increasingly are held accountable for quality of services they provide
- Community is involved in management and sustaining systems improvements
- Community has a role in the maintenance of service quality
How do I learn more?
There are a number of good tools developed by NGOs to support community-facilities linkages:
Partnership Defined Quality: Partnership Defined Quality (PDQ) is a methodology to equitably unite community members (users and non-users of health services) with providers to define quality, identify and prioritize problems and create solutions to strengthen the quality, access and use of services that improve the health status for all. Originally designed for family planning / reproductive health programs, Save adapted this methodology to include maternal and child health programs. Save piloted the approach in Pakistan, Uganda, Rwanda, Azerbaijan, the West Bank, Georgia and Ethiopia and developed an implementation guide with step-by-step instructions for field use.
Client-Oriented, Provider-Efficient (COPE): Created by EngenderHealth, COPE is a process that helps health care staff continuously improve the quality and efficiency of services provided at their facility and make services more responsive to clients' needs.
Census-Based Impact Oriented Approach: Curamericas has developed and tested a model of health service delivery called the Census-Based, Impact-Oriented (CBIO) approach in Bolivia, Guatemala, Haiti and Mexico over the past 20 years. The CBIO approach is a community-based primary health care model that allows local health care staff to better understand and more effectively treat the most common causes of sickness and death within their communities. Because of its unique approach to measuring community health, the CBIO methodology provides a basis to accurately measure health service outcomes and impacts, including mortality reduction. The CBIO methodology seeks to ensure that: 1) scarce resources and services are appropriately targeted to the most common causes of avoidable illness and death; 2) service outreach and utilization are equitable, reaching those of greatest need within targeted communities; and 3) outcomes and impacts (including changes in mortality) are well measured.
Health Facility Assessments: The Rapid Health Facility Assessment (RFHA) tool developed by CSTS+ has been field-tested by several CORE Group members and provides a standardized approach to assessment of essential child health services.
Community-Based Health Information Systems: Community-Based Health Information Systems (CB-HIS) enable the collection of health information at the community level that can feed into both community and facility-based decision making on essential health service provision.
Can you apply Element 1 if there is no health facility?
Ideally, you will have all three components of IMCI (health worker training, health system supports, and the household and community component) working together. In this way, the greatest possible impact on child health and development will be achieved. However, many communities do not have adequate health facility access or access to a health facility with staff trained in IMCI and can still benefit greatly from household and community health interventions.
In this situation, one important role of efforts in element 1 can be to mobilize the community and advocate for service provision. Partnerships with the nearest health facility or district authorities could help extend support to the area via regular visits by clinic staff, provision of medical kits or other means of extending and improving coverage.
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