HAI Presents at International Conference on Community Health
The Rwandan Ministry of Health, with partners UNICEF and USAID, hosted the first annual International Conference on Community Health (ICCH) in Kigali on January 25-28, 2011.
One of our program staff from our Timor-Leste project, Lourenco Camnahas, attended the conference and presented a session on community-based delivery of family planning services in Timor. The presentation drew on work done by an MPH student who worked with the HAI-Timor team to assess a Ministry of Health program called SISCa, an acronym in Tetum which stands for Integrated Health Services at the Community Level. The SISCa initiative seeks to address problems with access to health services by delivering them in community settings.
SISCa events are put on in villages and offer six tables of information and care for community members, including maternal and child health and family planning, but also nutrition, hygiene and sanitation, general health and health promotion. HAI supports the Ministry of Health with these events by providing additional support and mentoring for the midwives and community health workers who organize and conduct the events. You can read more about this program on our web site here.
University of Washington student researcher, Jennifer Berthiaume, worked with HAI staff to look specifically at the effectiveness of SISCa in providing family planning services and counseling. The study involved observations of events as well as 41 key informant interviews with midwives, nurses, family health volunteers, community members, district health staff and NGO staff.
Lourenco shared the results of this study with the conference attendees--more than 350 participants from more than 15 countries, as well as other NGOs.
Findings were largely positive: many women had heard of family planning (76%) and almost one-third reported having a conversation about family planning with their spouse or family (29%). Women felt a sense of trust with the community health workers and spoke of establishing stronger relationships with health staff since the commencement of SISCa. Some women reported reluctance to ask midwives about family planning without their husband present. Where women preferred to get family planning information varied, some preferred the health facility and others preferred home or at SISCa.
Other challenges in the provision of family planning services via SISCa were stock-outs of some methods (pill and injectables), lack of midwives present at SISCa, lack of a private space to discuss family planning options, and the challenge of delivering some methods (IUD and implants) in a community setting.
Based on this evaluation, HAI recommended that the Ministry of Health develop some take-home materials about family planning, pilot models for community health workers to deliver home-based family planning services, and train nurses in family planning counseling in addition to midwives.
Lourenco (back row, center) at the conference, next to the Rwandan Minister of Health (Photo: HAI/L. Camnahas)
Lourenco also reported back on some of the innovative best practices in other countries, including Rwanda's RapidSMS program which provides 60,000 community health workers with mobile phones and solar chargers to facilitate reporting of data on pregnancies, emergencies, immunizations and other information back to the Ministry of Health in real time. Rwanda has also implemented a performance-based financing system for community health worker groups, where the achievement of certain target levels of service utilization in a community results in a payment from the Ministry of Health to a community health worker cooperative group.
We were also proud to have Lourenco represent HAI, as well as other international visitors and presenters, by giving some closing remarks at the invitation of the conference organizing committee.
More information and presentations from the conference are posted on the conference web site (visit each day of the conference for a detailed agenda and links to presentations).
Lourenco's presentation is also available here.
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