G. Karimova1, Z. Mengliboeva1, P. Mukhtarova2, L. Sattori3, E

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"Community Involvement in Health Planning and Health Literacy Levels in Rural Tajikistan" G. Karimova1, Z. Mengliboeva1, P. Mukhtarova2, L. Sattori3, E. Hoffmann1, B. Matthys4, H. Prytherch4 1Enhancing Primary Health Care Services-Tajikistan Project, Dushanbe, Tajikistan; 2Republican Healthy Lifestyle Centre, Dushanbe, Tajikistan; 3Save the Children Tajikistan, Dushanbe, Tajikistan; 4Swiss Tropical and Public Health Institute, Basel, Switzerland Background The Enhancing Primary Health Care (PHC) Services project supported by the Swiss Agency for Development and Cooperation aims to strengthen primary health care services in selected pilot districts in rural Tajikistan. The active involvement of communities in the health planning process as a partner of PHC Services and the Republican Healthy Lifestyles Centres (RHLSC) has become an important part of comprehensive activities on PHC development. In this context, Community Health Teams (CHT) have been built, to establish a process towards participatory social services. A community-based health work plan methodology was developed and introduced in 2014 and community members were actively engaged in the health planning process through CHT Representatives. Objective We assessed the level of involvement of adult villagers in the annual health planning in 2016, the extent to which they considered being able to contribute shaping this process and the knowledge and behavior of the adult population related to cardiovascular risk factors (cvRF) as a proxy for health literacy levels. Methodology Adults from 60 randomly selected project villages were interviewed in 2017 on knowledge of cvRF and associated health behavior. Community representatives from 40 sub-sampled villages explained their experiences from the health planning cycle in 2016. The degree of involvement of the community into health planning and collaboration with the PHC team in 2016 was assessed by interviewing in each of the selected study villages all 3 CHT Representatives who were actively involved in this process. For the CVD aspects this was a follow up survey with this data having also been collected in a baseline study in 2015. The study design and implementation was overseen by the project with data collected by the Republican Healthy Lifestyle Centre. Findings 121 Community representatives aged between 19 and 65 years were interviewed. They exerted influence towards the PHC team by successfully bringing in the communities’ health concerns, and by reinforcing the people’s confidence in PHC services. Group meetings and public events were used to identify people’s concerns and transmit information from the PHC team. 1’197 adults were interviewed in 2015 and 1’201 in 2017. The knowledge on cvRF was higher in 2017 with 69% of the respondents having a fair to good knowledge compared to 54% in 2015. Interviewees were more conscious of their own health and of being capable to control it. Measures applied in the daily life such as a diet or physical exercises were more often mentioned. Community Health Promotion Event (Swiss TPH Tajikistan) Woman Identifying Priority Health Needs (Swiss TPH Tajikistan) CHT Representatives’ achievements Organized group meetings in public places; Identified community health priorities and brought in the communities’ needs into health planning; Contributed to implement the health plans in partnership with PHC/HLSC services; Performed advocacy for health promotion at community level; Had influence on the improvement of the accountability of PHC institutions to communities; Enhanced the mutual confidence between users and providers of PHC services; Reinforced their own competency in communication skills, technical knowledge and community work experience; Health workers’ trust for mutual cooperation and respect and esteem from the villagers, empowering them to raise their sense of personal achievement and status; Encouraged the people in believing having a say in the annual health planning. Conclusions Recommendations pertain to further engage the communities in the health planning process through active participation of their representatives in meetings with the PHC team, and by better informing the people on their co-determination in shaping the local health agenda. The guideline on “Partnership with communities on health issues” envisage health promotion and awareness-raising activities to be conducted jointly by PHC teams, the Healthy Lifestyle Centre and community representatives, whereby PHC services acting as interface for community-identified priorities. Swiss TPH, Socinstr. 57, P.O. Box, 4002 Basel, Switzerland T +4161 284 81 11, F +4161 284 81 01, www.swisstph.ch