Community strategy

Goal: Improve understanding on community strategy

Specific objectives:
 To understand the meaning and objectives of community strategy
 To define the household and community roles in community strategy
 To understand the implementation process of community strategy
 Improve knowledge on community involvement and participation in sustaining health programs
 To gain practical experience on community units

Community strategy - this is an approach that sets up an assurance that Kenyan communities have the
capacity and motivation to take up their essential role in health care delivery

National Health Sector Strategic Plan – This is a five year plan that aims at reversing the declining
trends in key health sector indicators. The NHSSP II has five broad policy objectives:
 Increase equitable access to health services
 Improve the quality and responsiveness of services in the sector
 Improve the efficiency and effectiveness of service delivery
 Enhance the regulatory capacity of MOH
 Foster partnerships in improving health and delivering services
 Improve the financing of the health sector

Kenya Essential Health Package of Health - KEPH is an approach that supports the achievement of the
goals of the second National Health Sector Strategic Plan, 2005–2010 (NHSSP II). The packages are:
 Eliminate communicable conditions
 Revise rising burden of non-communicable conditions
 Reduce the burden of violence and injuries
 Provide essential health services
 Minimize exposure of health risk factors
 Strengthen collaboration with other related health sectors

Household – It consists of one or more people who live in the same dwelling and also share at meals or
living accommodation, and may consist of a single family or some other grouping of people. A single
dwelling will be considered to contain multiple households if either meals or living space are not shared.

Community mobilization – is an attempt to bring both human and non-human resources together to
undertake developmental activities in order to achieve sustainable development.

Community participation – can defined as the involvement of people in a community in projects to solve
their own problems
Goal- is a desired result that a person or a system envisions, plans and commits to achieve. The overall
goal of the community strategy is to enhance community access to health care in order to improve
productivity and thus reduce poverty, hunger, and child and maternal deaths, as well as improve education
performance across all the stages of the life cycle.

Objectives – the objectives of community strategy are as follows:

 To improve the health status of Kenyan communities through initiation and implementation of life-
cycle focused health actions.
 Provide level 1 services for all cohorts and socio-economic groups taking in to account their
priority needs
 Build the capacity of community health extension workers (CHEWs) and community own resource
persons (CORPS) to provide services at level 1
 Strengthen health facility- community linkages through effective decentralization and partnership
 Strengthen the community to progressively realize their rights for accessible and quality care and to
seek accountability from facility based health services

How it came about

 Communities are at the foundation of affordable, equitable and effective health care, and are the
core of Kenya Essential Package for Health (KEPH)
 The concept came about after seeing the need to enhance community access to health care in order
to improve productivity and reduce poverty, hunger and child & maternal dearth as well as improve
education performance across all stages of the life cycle
 Kenya realized the need of establishing sustainable and decentralized community level services and
accountability

Roles of households and community

 Health promotion – through:
o Ensure healthy diet for people at all stages in life in order to meet nutritional need
o Building healthy social capital to ensure mutual support in meeting daily needs
o Demand health and social entitlements as citizens
o Monitor health status to promote early detection of problem for timely action
o Taking regular exercise
o Ensure gender equity
o Use available services to monitor nutrition, chronic conditions and other causes of disability

 Disease prevention – through:

o Practice good personal hygiene in terms of hand washing, use of latrine etc
o Using safe drinking water
o Ensure adequate shelter and protection against vectors of diseases
o Preventing accidents and abuse and taking appropriate measures when they occur
o Ensuring appropriate sexual behavior to prevent STI
  Care seeking compliance with treatment and advice –through:
o Giving sick household members appropriate home care for illness
o Taking children for immunization as scheduled
o Recognizing and acting on the need for referral or seeking care outside home
o Following recommendations given by health worker in relation to treatment, follow up and
referral
o Ensuring that every pregnant woman receives antenatal and maternity care services

 Governance and management of health services – through:

o Attending and taking an active part in meetings to discuss:
 Trends in coverage
 Morbidity
 Resources and clients satisfaction

 Claiming rights – through:

o Knowing what rights communities have in health
o Building capacity to claim these rights progressively
o Ensuring that health workers in the community are accountable for effective health service
delivery and resource use
o Ensure health facilities are functioning in line with the Citizen Health Charter

Community mobilization -This is the process of bringing the community members together. It is is an
attempt to bring both human and non-human resources together to undertake developmental activities in
order to achieve sustainable development
 is a process through which action is stimulated by a community itself that is planned, carried out,
and evaluated by a community’s individuals, groups, and organizations on a participatory and
sustained basis to improve the health, hygiene and education levels so as to enhance the overall
standard of living in the community
 is a process which begins a dialogue among members of the community to determine who, what,
and how issues are decided,
 The process of sensitizing and motivating the community to work together
 Effective mobilization will ensure the community’s interest is created and community members are
motivated and influenced to take action and participate
 Mobilization is done through community gatherings, baraza, village health days, women and youth
groups

Steps of community mobilization

o Getting to know the community, provide information & create interest
o Analysis + Identification resources + Problem identification + Identification solutions & projects
o Decision making & selection of leaders by community
o Identification of stakeholders
 o Planning & selection of implementing leader
o Project implementation by community
o Follow-up & monitoring
o Evaluation

Tasks in community mobilization

o Developing an on-going dialogue between community members
o Creating or strengthening community organizations (Committees etc.)
o Creating an environment in which individuals can empower themselves to address their own and
their community’s needs
o Promoting community members’ participation

Community involvement and participation - Community involvement is the process of letting the
community members play active role in any activity. A project is more likely to fail if there is no
community ‘buy in’ - Sometimes this is because the project was introduced by ‘experts’ who had their own
ideas about what should be done. This is called the top-down approach

 Importance of community involvement and participation

 It promote ownership and accountability
 CORPS learn much faster when they participate
 Community can participate in health promotion, advocacy, follow up
 It is often better to use a participatory approach to ensure the project’s sustainability
 The participation helps to ensure that programmes are equitable and effective.
 Participation can positively impact the health, well-being and safety.
 Communities have different needs, problems, beliefs, practices, assets, and resources related to
sexual health. Getting the community involved in program design and implementation helps
ensure that strategies are appropriate for and acceptable to the community and its youth.
 Community participation promotes shared responsibility by service providers, community
members, and youth themselves for the sexual health of adolescents in the community.
 Community participation can increase the accountability of sexual health programs and service
providers.
 Participation can empower youth within the community

 Key messages to community involvement and participation

 Special attention should be given to ensuring that all groups are able to participate, including
those with specific needs and/or those who are marginalized and lacking a voice in decision-
making.
 Participation structures and procedures may require targeted effort and additional resources; it is
an essential way of reinforcing a sense of dignity, reducing vulnerability and helping to build
local capacity without undermining peoples’ own coping strategies in times of crisis.
 Participation should be based on assessments of existing structures which can be used to support
participatory methods.
  Participatory approaches should respect local culture there needs to be due regard for culturally-
embedded power relationships which may be exploitative or oppressive.
 Participation and community involvement should be planned and integrated into all stages of
the project cycle – assessment, planning, implementation, monitoring and evaluation
 A community's members are a rich source of knowledge about their community and of energy
and commitment to that community

Procedures of community based research

 Purposes of community based research:
o There is increased focus of funding agencies and researchers on approaches to public health
research
o Influence of social and political systems on behavioral and health outcomes

 Principles of community-based research:

 Respect for community interests that go beyond those of individual potential research subjects
 Identification of potential community stakeholders as well as individual research subjects.
 Inform the community stakeholders and potential research subjects about the research.
 Invite feedback regarding concerns about the research from community stakeholders and
individual potential research subjects.
 Partnership establishment
 Respect the community partner's interest in the project and be open to ways that the community
might benefit or want to use the information.
 Disseminate research findings to both community stakeholders and individual research subjects.
 Having the research topic address a community-defined need, question or problem, and strive to
combine knowledge with action to achieve necessary changes.
 Recognizing the research as a partnership and be open to the guidance of community insight and
experience.
 Having the partnership appropriately balance power and decision-making between the
researchers and the community participants in a way that is mutually acceptable.
 Partners making clear and open communication an ongoing priority by striving to understand
each other's needs and self-interests.
 Partners recognizing race, ethnicity, class, and other aspects of culture matter and talk openly
about these issues.
 Feedback among all stakeholders in the partnership, with the goals of continuously improving
the partnership and its outcomes.
 Realizing partnerships can dissolve and plan a process for closure

Income generating activities

 This is a mechanism for sustainability
 The CORPS get involved in activities that give them revolving funds
 Some of the IGAs include kitchen gardening, poultry raring, merry-go-round (chama)

Skills in training a community resource person

 Adult learn best through illustrated lectures, discussions, brainstorming, group work and feedback,
role plays, demonstration, community or household visit, transect walk in PRA, observation and
resource mapping.
 Adult learning theory: problem-based and collaborative
 Principles of adult learning:
o Adults are internally motivated and self-directed
 Adult learners resist learning when they feel others are imposing information, ideas or
actions on them.
 A facilitator should:
 Set up a graded learning program and do not overloading for the student.
 Develop rapport with the student and show interest in their opinion
 Lead the student toward inquiry before supplying them with too many facts.
 Provide regular constructive and specific feedback
 Review goals and acknowledge goal completion
 Encourage use of learning resources
 Acknowledge the preferred learning style of the student.

o Adults bring life experiences and knowledge to learning experiences

 Adults like to be given opportunity to use their existing knowledge and experience gained
from life experience, and applies it to their new learning experiences.
 Find out about your student - their interests and past experiences
 Assist them to draw on those experiences
 Facilitate reflective learning opportunities

o Adults are goal oriented

 Adult students become ready to learn when "they experience a need to learn it in order to
cope more satisfyingly with real-life tasks or problems"
 As educator, you can:
o Provide meaningful learning experiences
o Provide real case-studies
o Ask questions that motivate reflection, inquiry and further research.

o Adults are relevancy oriented

 Adult learners want to know the relevance of what they are learning to what they want to
achieve.
 Ways of helping learners see the value of their observations and practical experiences are:
o Ask the student to do some reflection
o Provide some choice of fieldwork project by providing two or more options, so that
learning is more likely to reflect the student's interests.

o Adults are practical

 Students move from classroom mode to hands-on problem solving
 A trainer should:
o Clearly explain your clinical reasoning.
 o Be explicit.
o Promote active participation

o Adult learners like to be respected

 Respect can be demonstrated to your student by:
o Taking interest
o Acknowledging the wealth of experiences that the student brings to the placement;
o Regarding them as a colleague who is equal in life experience
o Encouraging expression of ideas, reasoning and feedback at every opportunity.

ENTRY POINT

 Community entry refers to the process of initiating, nurturing and sustaining a desirable relationship
with the purpose of securing and sustaining the community’s interests.
 It also refers to the process, principles and technique of community mobilization and participation
 A process of stimulating the community members to identify their problems and resources available
and instituting measures in solving their problems with the participation of the community
 During community entry the community health personnel is introduced to the local authorities and
other key people in the community.

COMMUNITY ENTRY PROCESS

PHASE 1

PLANNING

 Get ready – have a plan. Include community entry activities like community visits, information
materials, transportation to the new community
 Select a community – gather information. Before approaching a community there are
several actions you can take to make sure you are selecting a community that will be
interested and ready to participate.
Do some fact- finding about the community. Maybe your organization or partners have
worked in the community before and knows someone from the community. How can these
contacts help you gain access to the community leaders? Search to see if there is background
information about the community that you can review.

COMMUNITY PROFILE

WHAT IS A COMMUNITY PROFILE?

Community profile is a write up which summarizes the main characteristics of a community that is its main
features resources and needs

It is a document that inform the health worker of what the community is, what it has, what it doesn’t have.
MAIN FEATURES DESCRIBED IN A TYPICAL COMMUNITY PROFILE

 Name of the community

 Name of the sub district
 Name of the villages
 Brief definition of landscape and vegetation
 Population of community
 Main customs and beliefs of the people
 Pre dominant religious groupings
 Economic activities, sources of income
 Economic facilities that is markets, shops etc.
 Forms of transportation
 Forms of communication
 Water facilities
 Sanitation facilities
 Housing – nature and pattern of housing
 Schools and other education facilities
 Health facilities – hospitals, clinics, traditional healers, TBAs, health posts and chemist shops
 Disease patterns – most common causes of diseases, most frequently diagnosed diseases, most usual
and unusual health problems
 Sickness and health behaviors – who people see for health when they are sick, what people do to
prevent illness, what role traditional healers and TBAs play in health delivery.

 Identify influencers/reference groups – leaders, role models and other people who are revered in
some way in the community influence opinions, beliefs and behaviors and as such, set and reinforce
social norms. These influential people make up a reference group. That is community members
“refer” to this group for cues about how to behave.

Reference groups are also often good at helping to organize the community. Their involvement will help
add importance to the program and the issues it addresses. The community members will also participate
freely without fearing negative repercussions.

 Decide on a community entry strategy – plan for your community entry strategy that is think about
what activities will more likely bring interest and commitment from the community. Consider these
questions
 What time of the year would be best to approach this community? you may want to avoid
peak harvest times, religious holidays , period where elections are taking place
 Which reference group will you approach first?
 How will you approach the reference group? will we request a face to face meeting,
formally schedule a meeting or visit the community unannounced
 What materials will you bring? something in writing or video ( presentation materials
  Prepare information materials for key audiences – it is likely that you are going to need materials
describing your program/agenda. You need these materials to assist you while describing the
program/agenda during the meeting or presentation or leave with community members for review
after you leave.

Example

 Written description of the program – full name of the program, who it is for men/women.
Program’s overall goal, incentives that they may receive, organizations contact information, who
will facilitate it
 Photographs from a previous program
 Video
 Participant testimony

PHASE 2

Entering the community

 Meet with the community – introduce yourself and set a collaborative tone. Thank the leader(s)
for their time and willingness to talk with you. Explain why you want to meet with them and why
their community has been selected for the program. Demonstrate understanding and empathy –
show them that you understand the issues and have done your homework about the community.
Secure commitment by explaining why you need their support or partnership. be specific on what
you would want them to do and make sure to thank them

 Be ready to answer questions – after presenting the program you are likely to receive questions.
Anticipate what these questions could be and have answers ready.

 Leave meeting with a clear list of next steps and commitments – after meeting with the
community leaders/ community members clearly communicate about the next steps for bringing the
program into their community. Let them know what they can expect you to do and by when . let
them also know what tasks you would like them to complete and by when.
Communities are more likely to feel engaged when they are left with an action item.

PHASE 3

 Nurture relationships with reference groups – always remember community entry is a process.
In order to maintain access to the community, relationships need to be nurtured especially among
the leaders who opened the door for you. Remember that these leaders are important reference
groups. To nurture this relationship one could:
  Invite them to welcome participants at the first session of the program and make opening
remarks and make closing remarks at the last session
 Share evaluation findings and ask the feedback
 Consider a small incentives for their support
 Ask them to visit sessions (if they are not participating directly)
 Communicate regularly by visiting face to face email, phone or text. Let them know about
progress, remind them about tasks they committed to do.

ADVANTAGES/BENEFITS OF AN EFFECTIVE COMMUNITY ENTRY PROCESS

 It helps to observe protocols

 It helps to gain support from the community leaders
 It ensures the establishment of good working relationship in all aspects of the program
 It ensures that objectives are achieved
 Helps one plan his/her work
 Increasing program participation
 Building community capacity
 Mobilizing and empowering the community
 Evaluating the program
 Assessing for and better understanding of community needs and assets

SKILLS AND ATTITUDE REQUIRED IN UNDERTAKING EFFECTIVE COMMUNUTY

ENRTY

SKILLS

 Maintain good eye contact

 Listen to both sides of the issue
 Paraphrase
 Show interest
 Be empathetic
 Encourage others to listen

ATTITUDES

 Patience
 Tolerance
 Respect for other people – do not discriminate anyone
 Good listening attitude
 Humility
SKILLS AND ATTITUDE

It is important to:

 Ensure that community members understand the message and are encouraged to ask questions when
necessary
 Ensure that message is clear and avoid unnecessary semantics and jargons
 Encourage effective dialogue through the use of effective two way communication skills
 Create humor and interact in a way that helps to build the environment for effective interpersonal
relationship

DEFINING COMMUNITY MONITORING AND EVALUATION

LINKAGE BETWEEN COMMUNITY UNIT AND HEALTH FACILITY MONITORING AND

EVALUATION ACTIVITIES

We define community monitoring and evaluation as M&E activities that are concerned with the delivery of
services at the community level. Services at that level typically involve the use of community or outreach
workers to deliver medical or non-medical. (Prevention and social) services to community members
outside of health facilities. For instance during household visits or at outreach sites.

Community M&E is intended to track, understand and ultimately improve the quality and reach of services
that are provided by CBOs and CWs to communities. While the services being monitored and evaluated are
provided at the community level, the M&E activities themselves can be implemented anywhere along the
continuum from the community to the international level.

Examples of M&E activities deemed to be community M&E include:

 The development of national indicators for a CHIS (Community health information system)
 Supportive supervision by CBO staff to improve the quality of data collected by outreach workers
 The use of community data by donors to inform strategic programming

NB: To improve the health and related services that are provided at the community level also requires
strengthening the M&E systems that are applied at that level

Community M&E
 International

National

District

CBO/NGO

Community

In this report we use the term CHIS to refer specifically to the collection of data on medical services
provided at the community level, outside of health facilities , that are intended to be linked to the formal
health management information system (HMIS)