Community Health Systems Strengthening

With a shortage of 7.2 million healthcare workers worldwide, the global health system lacks the manpower necessary to optimally treat the world’s population. This is particularly felt by communities who face long travel and poor access to formal health facilities. A strong community-level health system will increase access to care and can improve health outcomes. Community level provision of health care is often approached from a singular intervention view rather than from a holistic and systematic approach that encompasses the full range of health services and support required for successful service delivery at this level. Advancing Partners and Communities (APC) aims to identify the structures required for community-based services and support systems needed for community health workers and community members. Through APC’s community health systems strengthening work, ministries of health, NGOs, and donors may be better positioned to implement more effective and streamlined approaches to community-level service delivery.

Photo credit: Jane Silcock/USAID

Below you will find links to resources created by APC and other organizations.

APC Resources

The Importance of Applying a Comprehensive Approach to Mental Health Interventions in Fragile States
October 2018 | Reflections

Intervening through a comprehensive approach in an under-resourced sector, such as mental health, increases its opportunity of success, as it improves understanding and acceptance of mental health issues at the community level. This intervention has serviced the general population of Sierra Leone and provides a foundation for mental health services for the future.

Responding to Ebola Survivor Needs Strengthens the Health System in Sierra Leone
September 2018 | Reflections

In Sierra Leone, integrating Clinical Training Officers and Referral Coordinators within the existing health structures of service delivery and management has strengthened their mandate and benefited other categories of vulnerable groups.

Post-Ebola Recovery: Strengthening Community Health Services Endline Facility Assessment Report
June 2018 | Report

In response to USAID’s investment to restore and recover basic essential health services, Advancing Partners & Communities aimed to improve access to and availability of high-quality RMNCH services within primary health care facilities and at the community level in Sierra Leone.

Programme de prevention de la transmission d’ébola et de renforcement des services pour les guéris d’ébola Aperçu du programme: Guinée
January 2018 | Project Highlight

In Guinea, the ETP&SS program works to implement the Ministry of Health’s national plan for survivors to mitigate the risk of resurgence of the Ebola virus, support clinical care, and reduce stigma and other barriers for survivors to access needed health care.

An Ebola Survivor Cares for Fellow Survivors in Sierra Leone
January 2018 | Project Highlight

Sorie Samura is one of less than 70 health workers who contracted EVD and survived. He is now back in active service working as a Referral Coordinator for King’s Sierra Leone Partnership (KSLP) at Connaught Hospital in Freetown, the largest government hospital in Sierra Leone.

Mental Health Nurses and Disaster Response in Sierra Leone
January 2018 | Journal Article

Advancing Partners & Communities has supported mental health nurses in responding to the mudslide disaster in Sierra Leone.

Sierra Leone Photo Journal: Benguima Grassfield MCHP
January 2018 | Project Highlight

The USAID-funded Advancing Partners & Communities project provided support to revitalize the Benguima Grassfield maternal and child health post with infrastructure renovations, improved access to water, sanitation, and solar electricity, as well as capacity building of health professionals and community health workers.

Ebola Transmission Prevention & Survivor Services Program Overview: Guinea
January 2018 | Project Highlight

In Guinea, the ETP&SS program works to implement the Ministry of Health’s national plan for survivors to mitigate the risk of resurgence of the Ebola virus, support clinical care, and reduce stigma and other barriers for survivors to access needed health care.

Ebola Transmission Prevention & Survivor Services, Sierra Leone
October 2017 | Project Highlight

In Sierra Leone, APC has received USAID Global Health Ebola Team funding to implement the Ebola Transmission Prevention & Survivor Services project in support of the Comprehensive Program for Ebola Survivors (CPES), jointly led by the Ministry of Health and Sanitation (MOHS) and the Ministry of Social Welfare, Gender and Children’s Affairs.

Community Health Systems Catalog Country Profile: Zambia
August 2017 | Country Profile

The Zambia country profile provides an overview of the community health system in Zambia according to the most up-to-date policies available.

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Below are select resources related to key issues within community health systems strengthening.

Men’s Engagement in Family Planning

Increasingly, family planning programs understand the need to foster male partners’ active and supportive roles in planning their families. Family planning is often seen as solely a woman’s concern, and yet many women do not have the power to access and use contraception without the permission, cooperation, or support of their spouses or family members. Moreover, norms of masculinity in many areas place a high value on men’s virility and ability to father children and discourage health-seeking behaviors of men, which can be perceived as a sign of weakness.

Men’s roles in family planning may range from open communication and shared decision-making with their female partners about ideal family size and family planning methods, to financial support for accessing family planning, to men’s own uptake of vasectomy and condom use. Efforts to encourage men to become involved in planning their families can also lead to overall improvements in couples’ communication.

Becoming a Model Man
August 2016 | Video

FHI 360, in partnership with Advancing Partners & Communities, implemented Emanzi, a peer intervention program in Uganda, to teach men how to become better husbands and partners. Emanzi, which means role model in the local language, introduces the basic concepts of gender and gender norms, reflects on the injustice of violence against women, encourages positive communication among couples, and reviews the benefits of family planning and HIV testing. More than 850 men ages 18 to 45 have graduated from the program, and an evaluation is under way. Learn more about Emanzi in this presentation given at the 2016 Gender 360 Summit. 

Gender Norms of Health Care Providers

Gender norms are part of the community and affect everyone. Community health programs must recognize that everyone, including program designers and healthcare providers themselves, are socialized into certain ways of thinking and behaving as women and men, and about women and men. As a result, women and men often experience stigma and discrimination from healthcare providers. Healthcare providers should receive training in gender sensitivity to challenge their thinking about gender norms and be mindful of gender issues when interacting with clients.

Female Community Health Volunteer National Survey Report 2014
January 2016 | Report

The 2014 Female Community Health Volunteer (FCHV) survey provides a comprehensive assessment of the FCHV program in Nepal. The document reports the findings of a national-level quantitative survey of FCHVs and from complementary qualitative interviews with key national, district level, and community stakeholders. The results are intended to increase understanding of the current status of the FCHV program and reflect on stakeholder perceptions of program experience and performance.

Community Health Worker Motivation

In the face of global health worker shortages, the use of community health workers (CHWs) is an important health care delivery strategy for underserved populations. In Uganda, community-based programs often use volunteer CHWs to extend services, including family planning, in rural areas. This study examined factors related to CHW motivation and level of activity in three family planning programs in Uganda.

Community Health Policy Matters
May 2017 | Video

APC’s Community Health Policy Matters video tells the story of fictional characters Winnie and Mary, and how a fragmented health system affects each woman’s ability to access family planning services in her respective community. This animated video highlights how policy can improve the health system for women.

Sierra Leone National Community Health Worker Policy 2016-2020
February 2017 | Policy

Advancing Partners & Communities has provided training, technical assistance, and operational support for revising and implementing the MOHS’ CHW Policy. The policy is now a cornerstone of the Presidential Recovery Plan. 

Support to the Policy and Regulatory Framework for Improving Community Health Systems in Sierra Leone
October 2016 | Summary

Advancing Partners & Communities has been an active partner in the Community Health Workers (CHWs) policy revision process, offering ongoing technical assistance to the Ministry of Health and Sanitation (MOHS) of Sierra Leone.

Expanding global impact through Community Health Workers: progress and challenges in counting CHWs
March 2016 | Webinar

On March 2, 2016, World Vision, Frontline Health Workers Coalition & One Million CHWs Campaign hosted a webinar: Expanding global impact through Community Health Workers: progress and challenges in counting CHWs. The webinar presented key findings and discussed the relevance of the journey “from fragmentation to harmonization” for the CHW community at large.

Nepal’s Community-based Health System Model: Structure, Strategies, and Learning
January 2016 | Brief

The Community-based Health System Model briefs identify and discuss critical health system inputs and processes that have contributed to the implementation and expansion of community-based service delivery in different countries. Countries were selected for their geographic diversity, type of service delivery model, and programmatic scale-up. This brief reviews Nepal’s community health model to inform future policy, program design, and implementation in other countries.

Drug Shops

Until recently, the practice of utilizing drug shops to increase access to injectable contraceptives had not received sufficient attention in the literature. This new APC brief discusses the promising strategy. The U.S. Agency for International Development (USAID) has also developed a high-impact practice brief on family planning provision through both drug shops and pharmacies.

Delivery of Injectable Contraception by Drug Shop Operators in Uganda: Research and Recommendations
October 2016 | Brief

At the London Family Planning Summit in 2012, the Government of Uganda committed to providing universal access to family planning and reducing unmet need for family planning from the current 40 percent to 10 percent by 2022. To meet this ambitious goal, all potential means of increasing accessibility to family planning must be explored.

CHSS

Post-Ebola Recovery: Strengthening Community Health Services Endline Facility Assessment Report
June 2018 | Report

In response to USAID’s investment to restore and recover basic essential health services, Advancing Partners & Communities aimed to improve access to and availability of high-quality RMNCH services within primary health care facilities and at the community level in Sierra Leone.

Programme de prevention de la transmission d’ébola et de renforcement des services pour les guéris d’ébola Aperçu du programme: Guinée
January 2018 | Project Highlight

In Guinea, the ETP&SS program works to implement the Ministry of Health’s national plan for survivors to mitigate the risk of resurgence of the Ebola virus, support clinical care, and reduce stigma and other barriers for survivors to access needed health care.

Beyond the crisis: did the Ebola epidemic improve resilience of Liberia’s health system?
November 2017 | Journal Article

Although the Ebola epidemic stimulated some positive adaptations in Liberia’s health system, building a truly resilient health system will require longer-term investments and sustained attention long beyond the crisis.

Ebola Transmission Prevention & Survivor Services, Sierra Leone
October 2017 | Project Highlight

In Sierra Leone, APC has received USAID Global Health Ebola Team funding to implement the Ebola Transmission Prevention & Survivor Services project in support of the Comprehensive Program for Ebola Survivors (CPES), jointly led by the Ministry of Health and Sanitation (MOHS) and the Ministry of Social Welfare, Gender and Children’s Affairs.

Community Health Systems Catalog Country Profile: Zambia
August 2017 | Country Profile

The Zambia country profile provides an overview of the community health system in Zambia according to the most up-to-date policies available.

Endline Infographic: Improving Community Health Services in the Post-Ebola Context
June 2017 | Infographic

This infographic summarizes APC's work in strengthening critical health services in local communities in Sierra Leone, with focus on reproductive, maternal, newborn, and child health.

Technical Brief: Rebuilding Trust in Health Services: Engaging Communities through Facility Management Committees
June 2017 | Brief

This Technical Brief provides detailed information on APC's community engagement work through facility management committees under the Post-Ebola Rebuilding Health Services project in Sierra Leone.

District Summary: Western Area Urban
June 2017 | Summary

This District Summary provides detailed information on the work performed by APC in Western Area Urban District under the Post-Ebola Rebuilding Health Services project.

Strengthening Health Services as Part of the Post-Ebola Transition in Sierra Leone: Community Engagement Implementation Toolkit
April 2017 | Toolkit

The purpose of this toolkit is to guide the community engagement process for improved community ownership of peripheral health unit quality and catchment area health outcomes in support of the project’s Community Engagement Implementation Strategy.

Life After Ebola: Mothers Return to Health Facilities in Sierra Leone
April 2017 | Photo Gallery

After the Ebola epidemic, a community health center in Sierra Leone is now able to provide improved quality health care services, including family planning.

Post-Ebola Recovery: Strengthening Community Health Services Baseline Facility Assessment Report
April 2017 | Assessment

This baseline facility assessment was conducted to better understand the capacity and infrastructure of the health posts in the five priority districts of Sierra Leone, and to establish a benchmark against which improvements made throughout the course of APC's work can be measured.

Community Health Policy Matters
April 2017 | Video

APC’s Community Health Policy Matters video tells the story of fictional characters Winnie and Mary, and how a fragmented health system affects each woman’s ability to access family planning services in her respective community. This animated video highlights how policy can improve the health system for women.

Community Health Policy Matters

Community Health Policy Matters from Advancing Partners & Communities on Vimeo.

Community Health Systems Catalog: 2017 Updates
April 2017 | Publication

APC’s Community Health Systems Catalog documents policy guidance across 25 countries in detailed profiles and data sets.

Understanding the Challenges of Delivering Community Maternal and Child Health Services in a Post-Ebola Context
October 2016 | Infographic

Following the Ebola epidemic, Sierra Leone faces challenges to rebuilding its community health system. This infographic helps explain the challenges of delivering community maternal and child health services in a post-Ebola context.

Program Overview: Sierra Leone, Liberia & Guinea
October 2016 | Publication

The Ebola Transmission Prevention and Survivor Services Program (ETP & SS) launched in July 2016 and is operating under the umbrella of priorities set by USAID’s Global Health Ebola Team. The program works with ministries of health and nongovernmental organizations in regions of Sierra Leone, Liberia, and Guinea that are most affected by the Ebola outbreak.

Sierra Leone: Community Engagement Implementation Strategy & Toolkit
April 2016 | Strategy

Advancing Partners & Communities has drafted a community engagement strategy for adoption and use by all implementing partners in the project’s five districts. In line with the project’s goal of strengthening health services, the strategy focuses on district- and facility-level interventions and emphasizes the role of community health workers (CHWs). The strategy complements other community-based interventions.

Advancing Partners & Communities, Sierra Leone: Program Overview and Accomplishments
March 2016 | Summary

Advancing Partners & Communities received a grant from USAID’s “Ebola Response and Preparedness” funds authorized by the United States Congress to strengthen critical non-Ebola health services, in Sierra Leone. 

Strengthening Community Health Systems through CHWs and mHealth
January 2015 | Paper

This paper details new learning and next steps from CORE Group’s Fall 2014 Global Health Practitioner Conference. Participants at the conference explored the role of NGOs in strengthening health systems from a primary health care perspective that includes community systems, with a focus on supporting community health workers (CHWs).

Using Measurements of Unmet Need to Inform Program Investments for Health Service Integration
June 2014 | Journal Article

This journal article discusses how Demographic and Health Survey (DHS) data could potentially inform optimal strategies to reach women having unmet need with contraceptive services through integrated service delivery. The analysis has the potential to provide program managers with an evidence-based road map indicating which service-delivery platforms offer the greatest potential to reach the largest number of women with unmet need for contraception.

Frontline Health Workers: Expanding Utilization of Family Planning
May 2014 | Fact Sheet

This fact sheet outlines the crucial role frontline health workers play in increasing contraceptive use in their communities by providing data and using several success stories to illustrate accomplishments.

PMA2014/Ethiopia
March 2014 | Infographic

This infographic is designed to show key family planning indicators and indicators for access, equity, quality, and choice for households in Ethiopia using family planning services from January to March 2014.

Community Health Workers in Low-, Middle-, and High-Income Countries: An Overview of Their History, Recent Evolution, and Current Effectiveness
March 2014 | Journal Article

This journal article discusses how over the past half-century, community health workers (CHWs) have been a growing force for extending health care and improving the health of populations. The review highlights the history of CHW programs around the world and their growing importance in achieving health for all. Note: A subscription is required to read the full article.

Ethiopia meets MDG 4 by cutting Under 5 mortality By Two-Thirds Since 1990
September 2013 | Report

This article reports on the success of meeting Millennium Development Goals with Community Health Worker programs in Ethiopia.

Factors Affecting Availability of Essential Medicines among Community Health Workers in Ethiopia, Malawi, and Rwanda: Solving the Last Mile Puzzle
November 2012 | Journal Article

This journal article focuses on the findings related to three key preconditions of the theory of change and how these were used to inform the design of the community case management supply chain improvement strategy in each country. The three key preconditions include product availability at CHW resupply points, supply chain knowledge and capacity among community health workers and their supervisors, and availability of appropriate transportation.

Created in 1979, our Non-Governmental Organization (NGO) – Action Against Hunger – is fighting against hunger in the world. Its mission is to save lives eradicating hunger through the prevention, detection, and treatment of malnutrition, in particular during and after emergency situations caused by conflicts and natural disasters. Today, Action Against Hunger is a major player in the fight against hunger in the world. Structured on an international network, our organization provides a coordinated response in nearly 50 countries.

ASA is an informal group of friends, non-profit, funded by private companies, made up of people with or without disabilities, that promotes the social integration of young people and adults with physical or sensory disabilities, through socialization spaces that allow know and transmit experiences of life and disability, strengthen self-concept and self-esteem, generate solid links for an exchange of mutual support, to make their relationship with the environment more positive.

CIDR works in key sectors of development in Africa: local development and decentralization; business development in rural and urban areas; decentralized financial systems; health insurance and social welfare. Created in 1961, the International Center for Development and Research studies, designs, implements operations and programs of socio-economic development in respect of socio-cultural choices of populations.

GOAL’s health programme takes a health systems strengthening approach. This involves working with ministries of health (where they exist) to ensure the provision of appropriate, affordable, accessible and quality services to poor, and often isolated populations, with extremely limited access to such facilities. Our programmes are integrated with educational initiatives around a range of health issues, including HIV, WASH and nutrition, and we work closely with civil society and government in their implementation.

El Instituto Nacional de la Salud (INSALUD) is a public health organization in the Dominican Republic. It was created in 1978 as one of the Managing Bodies of the Social Security; charge of the management and administration of health services Social Security System.

We provide training and deliver emergency health care and related services to those affected by conflict, natural disaster and disease no matter where they are, no matter what the conditions. We train people in their communities, providing them the skills needed to recover, chart their own path to self-reliance and become effective First Responders themselves.

King’s will continue to focus on world-leading education, research and service, and will have an increasingly proactive role to play in a more interconnected, complex world. Students will be educated to become rounded critical thinkers, with the character and wisdom to make a difference in the world around them. Through the highest quality disciplinary research and interdisciplinary collaborations, our students and staff will develop insights and solutions for the many and diverse challenges faced around the globe.

Our mission is to provide a preferential option for the poor in health care. By establishing long-term relationships with sister organizations based in settings of poverty, Partners In Health strives to achieve two overarching goals: to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair.

The National Academy of Sciences (NAS) is a U.S.-based, non-profit organization whose members serve as advisors to the nation on issues related to science, technology, engineering, and medicine. The society is comprised of peer-elected scientists regarded for their distinguished contributions to research. NAS members actively contribute to the scientific community domestically and abroad. Over 500 NAS members have won Nobel Prices, and the Proceedings of the National Academy of Sciences journal is internationally recognized.

Columbia University is an American private Ivy League research university located in New York City, New York. It is the oldest institution of higher learning in the state of New York and the fifth oldest in the United States.

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October 26, 2018 | Article

With help from USAID, APC enabled Liberian Ebola survivors to receive life changing cataract surgery in a program that also contributed to research on the persistence of Ebola virus in the eyes of survivors. This knowledge can help guide future outbreak response and helps us understand how the Ebola virus affects survivors many months after recovery. This complex program was made possible through a unique collaboration of faith-based organizations, universities, non-governmental organizations and government institutions.

October 24, 2018 | Article

On Friday, October 19, 2018, USAID Liberia Mission Director, Dr. Anthony Chan, officially turned over to the MOH a modern Infectious Disease Outpatient Clinic situated on the JFK Medical Center compound. The clinic was recently renovated through APC's ETP&SS program. 

July 26, 2018 | Event

APC held a high-profile closing ceremony for the Guinea-based Ebola Transmission Prevention & Survivor Services (ETP&SS) program on July 26, 2018 at the Hotel Riviera in Conakry. During the half-day event, Minster of Health Édouard Niankoye Lamah thanked the APC project for its efforts aiding Ebola survivors in Guinea and recommended continued follow-up to prevent a future outbreak.

June 28, 2018 | Announcement

On Thursday, June 28, 2018, the USAID-funded Advancing Partners & Communities (APC) project, through the Ebola Transmission Prevention and Survivor Services (ETP&SS) hosted a national learning conference for partners and stakeholders at the Embassy Suites Hotel in Monrovia.

June 27, 2018 | Article

Watch captivating videos and read more about the work APC is doing in Liberia to strengthen the health system and give hope to Ebola survivors.

May 25, 2018 | Announcement

On May 14, 2018, APC participated in a forum, hosted by USAID/Guinea in collaboration with the Ministry of Planning and International Cooperation, on improving Guinea’s resilience through sustainable development.

April 19, 2018 | Article

USAID, through the APC project, is helping the Government of Liberia to rehabilitate health services and provide services for Ebola survivors. All of this is being done with an eye toward long-term sustainability and enabling the health system to make continued improvements on its own.

March 29, 2018 | Article

Through APC's support, nurses, registered midwives and physician assistants from the four counties hardest hit by Ebola completed a six-month intensive training program on mental health.

March 26, 2018 | Article

JSI Research & Training Institute, through the Advancing Partners & Communities project, and the World Health Organization dedicated a refurbished and well equipped medical laboratory at the Tellewoyan Memorial Hospital in Liberia.

February 09, 2018 | Announcement

On January 30, 2018, Guinea’s National Network of Ebola survivors, Réseau National des Associations de Survivants d’Ebola de Guinée (RENASEG), celebrated the inauguration of its new headquarters in Conakry.

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October 2015 | Video

This video from Measure Evaluation tells a powerful story of how a simple innovation in a paper-based patient tracking system helped improve the health of mothers, newborns, and communities.

Mr. Tetteh (right) sharing ideas with a passenger

Bernard Tetteh is a 45 year old station guard and transport service operator in Anloga, in the Volta Region. As a station guard, he takes the opportunity to educate people on reproductive health issues.

Azalia

Azalia has worked in his role as premium collector for 13 years, a role that involves not just collecting premiums, but also educating villagers about the CHF and the value in joining.

Mrs. Diana Bona (standing) during one of her outreaches

Diana Bona, a public health nurse and the regional focal person for adolescent health in the Greater Accra region, is committed to increasing access to adolescent health education in schools within her region.

Head nurse Margarete Anthony, right, and colleague at the Sussex community health unit attend to a patient.

In April 2016, the Government of Sierra Leone launched a post-Ebola recovery plan with USAID support, which involved rehabilitating more than 100 peripheral health units in five priority districts through the Advancing Partners & Communities project.

Mrs. Patience Gyasi explains how to use the secure pill to a client.

Mrs. Patience Gyasi is a licensed chemical seller at the LA Dadekotopon District, in the Greater Accra Region. For the past 25 years, she has devoted her life to providing health care, including family planning services to her community.

Amadu Konneh and Joseph Diggs stand in the newly renovated office.

Short story of how APC helped organize the leadership of the National Ebola Survivor Network of Liberia.

HealthKeeper Tormeti introducing some products to clients.

A former worker of the Ghana Railways Authority, Angelina Tormeti is now a HealthKeeper who supports her family by selling family planning and other health products.

Jimaima outside her home in Liberia.

A mother of four and a first-year physician’s assistant trainee at the Tubman National Institute of Medical Arts, Jimaima was interning at the John Yekeh Memorial Clinic in Monrovia when she contracted the Ebola virus disease. Advancing Partners & Communities was critical in helping Jimaima find the necessary care post-Ebola.

Photo of Christine in a wheelchair

Christine was a normal, developing 14-year-old child until 2013 when she developed sudden weakness in her legs. She spent a month at Kenyatta National Hospital and was diagnosed with a rare medical condition known as Guillen Barre Syndrome.

Mariatu

Mariatu Conteh received life-saving dialysis under the Free Health Care Initiative with the help of Referral Coordinator Momoh Brima in Sierra Leone.

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