Building Community Orientated Building Community Orientated Primary Care in MaliPrimary Care in Mali

Group One Group One

Countries and their ContextCountries and their Context

All countries had some health system All countries had some health system infrastructureinfrastructure

The developing countries had challenges obtaining The developing countries had challenges obtaining robust technical informationrobust technical information

All except Macedonia, had a broad health policyAll except Macedonia, had a broad health policy All except Eritrea had political stabilityAll except Eritrea had political stability The developing countries had high levels of The developing countries had high levels of

informal private funding informal private funding The developed countries had formal private sector The developed countries had formal private sector

arrangements arrangements Brugha & Zwi (2002)Brugha & Zwi (2002)

Comparisons Comparisons With Other CountriesWith Other Countries

CountryCountry ChallengesChallenges GDP per capitaGDP per capita

MaliMali High infant and maternal High infant and maternal mortality, high mortality, high communicable disease communicable disease workforce, focus on hospital workforce, focus on hospital carecare

US$ 900US$ 900

MalaysiaMalaysia High communicable disease, High communicable disease, workforce, focus on hospital workforce, focus on hospital carecare

US $8,800US $8,800

MacedoniaMacedonia High non-communicable High non-communicable disease, workforce, focus on disease, workforce, focus on hospital care, ageing pop due hospital care, ageing pop due to migrationto migration

US $1800US $1800

Comparisons with Other Comparisons with Other CountriesCountries

CountryCountry ChallengesChallenges GDP per capitaGDP per capita

EritreaEritrea High infant and maternal High infant and maternal mortality, high mortality, high communicable disease communicable disease workforce, focus on hospital workforce, focus on hospital carecare

US $1053US $1053

EnglandEngland Inadequate human resourcesInadequate human resources

High incidence of non-High incidence of non-communicable diseasecommunicable disease

Focus on hospital careFocus on hospital care

US $ 25,500US $ 25,500

New ZealandNew Zealand Inadequate human resourcesInadequate human resources

High incidence of non-High incidence of non-communicable diseasecommunicable disease

Public focus on hospital carePublic focus on hospital care

US $20,100US $20,100

Key Problem for MaliKey Problem for Mali

High infant and maternal mortalityHigh infant and maternal mortality Preventable infectious diseasePreventable infectious disease Focus on hospital careFocus on hospital care Inadequate human resourcesInadequate human resources Private out of pocket expenses Private out of pocket expenses

VisionVision

Reduced neo-natal death ratesReduced neo-natal death rates Reduced maternal death ratesReduced maternal death rates Improved rates of immunisationImproved rates of immunisation Reduction of preventable, communicable Reduction of preventable, communicable

diseasedisease Community engagement with in own healthCommunity engagement with in own health

SolutionSolution

Building community-orientated primary care Building community-orientated primary care to develop a network of community-based to develop a network of community-based primary care centres to provide:primary care centres to provide:

Maternal and child health servicesMaternal and child health services ImmunisationsImmunisations Dietary adviceDietary advice Public health servicesPublic health services

To do this we needTo do this we need

The right type of servicesThe right type of services The right number of staff to provide the The right number of staff to provide the

services with the right skillsservices with the right skills Ensure that it can be paid forEnsure that it can be paid for To know the size of the problem and To know the size of the problem and

progress on addressing itprogress on addressing it

Implementation - StagesImplementation - Stages

Engagement and communicationEngagement and communication Gather information, surveys, analyse then Gather information, surveys, analyse then

needs assessmentneeds assessment Plan (build in information, monitoring and Plan (build in information, monitoring and

evaluation, timeframes and planning)evaluation, timeframes and planning) Resourcing (human and financial)Resourcing (human and financial) ImplementationImplementation ReviewReview

Key ActionsKey Actions

Engage the community in identifying local need, Engage the community in identifying local need, planning and developmentplanning and development

Train community and health professionals from Train community and health professionals from the hospitals in community orientated primary the hospitals in community orientated primary care and public health carecare and public health care

Seek aid money to build community infrastructure Seek aid money to build community infrastructure for for

Set up information and data collection frameworkSet up information and data collection framework Begin satellite services in the communityBegin satellite services in the community

Engaging communitiesEngaging communities

Engage with community leaders toEngage with community leaders to- develop messages and approach- develop messages and approach

- location of facilities- location of facilities- packages of care- packages of care- roles of community and secondary care - roles of community and secondary care

Media campaign using:Media campaign using:– RadioRadio– Clinical staff talking to groups of mothersClinical staff talking to groups of mothers-- Develop social marketingDevelop social marketing

Training Staff and CommunityTraining Staff and Community

Train the trainers in primary and public health Train the trainers in primary and public health carecare

Integrated Management of Childhood Illness Integrated Management of Childhood Illness (WHO programme) for health workers, (WHO programme) for health workers, community health workers and communities community health workers and communities

Immunisation training for health workersImmunisation training for health workers Training for community health workers Training for community health workers

(traditional birth attendants) in Child and (traditional birth attendants) in Child and Maternal Health Maternal Health

Satellite Community Health Satellite Community Health ServicesServices

Consult with community about their needsConsult with community about their needs(mix of services, locations)(mix of services, locations) Identify potential workers and traineesIdentify potential workers and trainees Identify what secondary services can be Identify what secondary services can be

shifted into the community shifted into the community Develop mobile resourcesDevelop mobile resources Training persons to develop basic recording Training persons to develop basic recording

and reporting system and reporting system

Information Information

Define minimum data setDefine minimum data set

(immunisation status, demographic (immunisation status, demographic information)information)

Establish simple networks of reporting Establish simple networks of reporting Conduct census of mothers and children Conduct census of mothers and children

(run at community centre) to establish basic (run at community centre) to establish basic needsneeds

Identify barriers to accessing servicesIdentify barriers to accessing services

Funding Funding

Cost out primary care infrastructure needsCost out primary care infrastructure needs Access international infrastructure funding Access international infrastructure funding

(MTEF)(MTEF) Review secondary system resources and Review secondary system resources and

identify what can be directed into primary identify what can be directed into primary carecare

Work with local co-operatives and Work with local co-operatives and committees to identify current out of pocket committees to identify current out of pocket expenses expenses

Potential ChallengesPotential Challenges

Community engagementCommunity engagement Cultural and gender issuesCultural and gender issues Possible community resistancePossible community resistance Clinical professionals’ engagement and Clinical professionals’ engagement and

alignmentalignment Inadequate funding Inadequate funding TransportationTransportation Cold chain maintenanceCold chain maintenance

How we will know we’ve done itHow we will know we’ve done it

Annual numbers of community run primary and Annual numbers of community run primary and public health centers growpublic health centers grow

Rates of immunisation increasesRates of immunisation increases Services re-orientated from secondary to primary Services re-orientated from secondary to primary

carecare Public focus on primary care firstPublic focus on primary care first Number of people accessing primary care Number of people accessing primary care

increasesincreases Reduction in morbidity and mortality rates of Reduction in morbidity and mortality rates of

communicable diseasescommunicable diseases

ConclusionsConclusions

Review of the outcomes of the first stage Review of the outcomes of the first stage Identify any needs for further improvementIdentify any needs for further improvement Ensure sustainabilityEnsure sustainability Provide opportunities for additional Provide opportunities for additional

expansion and development expansion and development