Working with some of the most respected and widely quoted close-to-community services in Africa and Asia we have started to identify how close to community (CTC) services can best be delivered in our partner countries and document generic lessons for health system development and strengthening.
The close to community services we have studied include those provided by community health workers, midwives, traditional birth attendants, informal private practitioners and lay counsellors.
Countries striving to provide universal health care coverage and achieve the Millennium Development Goals are increasingly implementing close-to-community (CTC) health services. There is a need for health systems to understand the context and conditions in which these services operate in order to realise their potential.
To maximize the equity, effectiveness and efficiency of close-to-community services in rural areas and urban slums in six countries: Bangladesh, Ethiopia, Indonesia, Kenya, Malawi and Mozambique.
Detailed desk reviews and context analysis research has taken place in each country in 2013. Qualitative interviews with key informants, CTC providers have revealed four emerging common areas of concern: supervision, community engagement, referrals and coordination of stakeholders. This baseline will guide cycles of interventions for service improvement.
We will build capacity on three levels: at practitioner level to enable improved service to be delivered; at researcher level to empower the next generation of researchers in health systems; at policy level to enable transfer of research experience into policy, planning and practice.
The interventions will be assessed using the framework to find out what works, in which context and why and what can be improved. Our impact on equity, efficiency and effectiveness will be evaluated using a combination of outcome and process indicators and multiple methods. Analyses will include community and policy maker perspectives and elaboration of CTC providers’ voices in health planning.
Through conducting a robust inter-country analysis we will build much needed transferable policy and practice recommendations to strengthen CTC services and empower providers, researchers and policy makers.
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