1. 1 Implementing the Community strategy for primary health care: key lessons for Africa Prof. Anthony K. Mbonye Director Health Services, Ministry of Health Uganda/School of Public Health Makerere University-Kampala.

2. 2 The underlying idea is that the involvement by ordinary citizens and civil society organizations will lead to increase in accountability. Empowering communities and service users is also embedded in the Primary Health Care concept - Alma Ata Declaration of 1978 The Ottawa Charter for Health Promotion of 1986. Why community health strategies? 2

3. 3 Poor access to health based interventions eg four visits of Antenatal care, 52%, skilled attendance at delivery 60%, access to two doses of IPTp 26%, postnatal care 25% Poor access to HIV testing, ART, stock-out of laboratory supplies etc Health system bottlenecks: inadequate staffing, inadequate skills, stock-out of essential commodities, rude health workers, absenteeism, poor motivation and pay, poor infrastructure Why community health strategies? 3

4. 4 Evidence on Community Delivery of IPTp for malaria Uganda (Mbonye 2007) Faso (Ouedraogo 2010) Uganda (Ndyomugenyi 2009 ) Community sensitization Training of community resource persons SP delivery by Dug Shop Vendors, TBAs, CRHMs 2 2 3 3 1 1 Increase IPTp-2 68% verses 40% in control Increase ANC attendance Health education messaging SP delivery by community drug distributors Increase IPTp2: Intervention 68% verses 40% control ANC attendance was maintained Community delivery Outreach delivery Increase IPTp2: Intervention 83% verses 46% control ANC attendance was maintained Malawi (Msyamboza 2009) Training community health workers SP delivery Increase IPTp:2 68% verses 40% in control ANC attendance reduced Studies SP delivery methods Results 4 4

5. 5 Challenges of community based strategies Policy Current policies prioritize health facility mode of delivery Most funding priorities are clinic based, less on prevention Community Acceptance Communities may not accept community health based interventions Motivation of community workers Most community health programs are voluntary leading to high levels of attrition Inadequate supervision and mentoring Data collection Community data not integrated into HMIS Inadequate research Commodities Frequent stock-outs of life saving commodities Poor logistic management system

6. 6 Key Lessons for Africa 6 Revise policies, guidelines and curriculum to support community delivery of key interventions targeting vulnerable groups (women and children) Leverage existing funding opportunities and projects (Global Fund, GAVI) to obtain resources to scale up community health interventions

7. 7 Design appropriate messages to support acceptance of community based interventions Integrate community data into national HMIS system to enhance monitoring and evaluation Support implementation research to identify best modalities to support community based interventions Key Lessons for Africa 7

8. 8 Design models for supervision and mentoring for community based interventions Design models of motivation and retention of community health workers Share best practices and lessons learned between countries Key Lessons for Africa 8

9. 9 9 END Thank you