Transcript Building Community Orientated Primary Care in Mali

Building Community Orientated
Primary Care in Mali
Group One
Countries and their Context
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All countries had some health system
infrastructure
The developing countries had challenges obtaining
robust technical information
All except Macedonia, had a broad health policy
All except Eritrea had political stability
The developing countries had high levels of
informal private funding
The developed countries had formal private sector
arrangements
Brugha & Zwi (2002)
Comparisons
With Other Countries
Country
Challenges
GDP per capita
Mali
High infant and maternal
mortality, high
communicable disease
workforce, focus on hospital
care
US$ 900
Malaysia
High communicable disease,
workforce, focus on hospital
care
US $8,800
Macedonia
High non-communicable
disease, workforce, focus on
hospital care, ageing pop due
to migration
US $1800
Comparisons with Other
Countries
Country
Challenges
GDP per capita
Eritrea
High infant and maternal
mortality, high
communicable disease
workforce, focus on hospital
care
US $1053
England
Inadequate human resources
High incidence of noncommunicable disease
US $ 25,500
Focus on hospital care
New Zealand
Inadequate human resources
High incidence of noncommunicable disease
Public focus on hospital care
US $20,100
Key Problem for Mali
High infant and maternal mortality
 Preventable infectious disease
 Focus on hospital care
 Inadequate human resources
 Private out of pocket expenses
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Vision
Reduced neo-natal death rates
 Reduced maternal death rates
 Improved rates of immunisation
 Reduction of preventable, communicable
disease
 Community engagement with in own health
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Solution
Building community-orientated primary care
to develop a network of community-based
primary care centres to provide:
 Maternal and child health services
 Immunisations
 Dietary advice
 Public health services
To do this we need
The right type of services
 The right number of staff to provide the
services with the right skills
 Ensure that it can be paid for
 To know the size of the problem and
progress on addressing it
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Implementation - Stages
Engagement and communication
 Gather information, surveys, analyse then
needs assessment
 Plan (build in information, monitoring and
evaluation, timeframes and planning)
 Resourcing (human and financial)
 Implementation
 Review
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Key Actions
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Engage the community in identifying local need,
planning and development
Train community and health professionals from
the hospitals in community orientated primary
care and public health care
Seek aid money to build community infrastructure
for
Set up information and data collection framework
Begin satellite services in the community
Engaging communities
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Engage with community leaders to
- develop messages and approach
- location of facilities
- packages of care
- roles of community and secondary care
Media campaign using:
– Radio
– Clinical staff talking to groups of mothers
- Develop social marketing
Training Staff and Community
Train the trainers in primary and public
health care
 Integrated Management of Childhood
Illness (WHO programme) for health
workers, community health workers and
communities
 Immunisation training for health workers
 Training for community health workers
(traditional birth attendants) in Child and
Maternal Health
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Satellite Community Health
Services
Consult with community about their needs
(mix of services, locations)
 Identify potential workers and trainees
 Identify what secondary services can be
shifted into the community
 Develop mobile resources
 Training persons to develop basic recording
and reporting system
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Information
Define minimum data set
(immunisation status, demographic
information)
 Establish simple networks of reporting
 Conduct census of mothers and children
(run at community centre) to establish basic
needs
 Identify barriers to accessing services
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Funding
Cost out primary care infrastructure needs
 Access international infrastructure funding
(MTEF)
 Review secondary system resources and
identify what can be directed into primary
care
 Work with local co-operatives and
committees to identify current out of pocket
expenses
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Potential Challenges
Community engagement
 Cultural and gender issues
 Possible community resistance
 Clinical professionals’ engagement and
alignment
 Inadequate funding
 Transportation
 Cold chain maintenance
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How we will know we’ve done it
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Annual numbers of community run primary and
public health centers grow
Rates of immunisation increases
Services re-orientated from secondary to primary
care
Public focus on primary care first
Number of people accessing primary care
increases
Reduction in morbidity and mortality rates of
communicable diseases
Conclusions
Review of the outcomes of the first stage
 Identify any needs for further improvement
 Ensure sustainability
 Provide opportunities for additional
expansion and development
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