expanded coverage of essential health services in djibouti project (pecse) from five villages to a...
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Expanded Coverage of Essential Health Services in Djibouti Project (PECSE)
From Five Villages to a National Policy:
Community Mobilization in Djibouti
Dr. Stanislas Nebie, Chief of Party, PESCE, JSIDr. Chehem Watta, Senior Advisor, Ministry of Health,
DjiboutiDekha Hadi, Social Mobilization Assistant, PESCE
Catherine O’Brien, Senior Technical Advisor, The Manoff Group
Elaine Rossi, Senior Technical Advisor, JSI
The authors’ views expressed in this publication do not necessarily reflect the views of the US Agency for International Development or the US Government.
Country Context: 2004
• Population: ~800,000• Size of US state of
Massachusetts• Life expectancy: ~46 yrs• Infant mortality: 103 per 1,000
live births (2002)• Under-5 mortality: 121 per
1,000 live births (2002)• Maternal mortality: 650 per
100,000 live births (2002)• Malnutrition, malaria, TB all
pose great risks
Health System Context: 2004
• Weak infrastructure
• Unreliable health statistics and poor health knowledge
• No community mobilization for health!
• MOH health sector reform strategy aims to increase access to health care through decentralization, prevention, and primary care
PECSE Project• 2004–2008• Expand access to
health services– Rehabilitate health
facilities– Train health care
providers– Establish health
management information system
– Mobilize communities
– Focus on rural areasSagalou Health committee members, April 2006. The Health Committee President is seated on the left.
Community Mobilization: Challenges
• No community mobilization existed before in the health sector
• MOH not receptive to idea• Health infrastructure in terrible condition• Nomadic populations; refugees• Difficult physical environment
Laying the Groundwork• “Back to Basics”• Not ready for
BCC• Pilot program in 5
sites in 2005• Very basic
community mobilization
PECSE and MOH staff in discussion with Goubetto community chief in 2005, when negotiating the establishment of a health committee
Community Mobilization Pilot Approach
• Health Post Health Committee community members forging links to improve services
• Community health volunteer is the link between community and health post staff
Daley Aff Community volunteers: Jan 2006
Involving the MOH
• PECSE cultivated excellent relations with MOH, UNICEF, WHO, NGOs, and others
• Study tour to Ethiopia and Madagascar
• Consensus on community mobilization emerged after study tour
• MOH interested in replicating model
Djibouti health committee members and nurses during the study tour in Madagascar, 2005
Scaling Up• 5 pilot sites 23
health posts• Each post linked to
health committee• Each committee has
men and women• 4 or 5 community
volunteers (at least 2 female) per community
Gallamo community leader giving working tools to a volunteer: May 2006
Training and Supervision
• Training-of-trainer workshops nationwide for community health volunteers
• Health education activities
• Joint supervision by MOH and PECSE
Dorra female health volunteer receiving a loud speaker for community mobilization: August 2006
Training
Work plan development during the Tadjoura district volunteers training: June 2006
Community trainer during Arta health committee members training: May 2006
Supervision
Randa village volunteers during supervision: Sept 2006
Gourabouss community volunteers during a supervision session: Aug 2006
Mobilization at work
• PECSE carried out MOH priorities
• Emergency immunization campaigns– Polio in 2005: Health Committees and
Volunteers proved themselves– Cholera in 2006: further validation
• Volunteers and committees trained in prevention and symptoms
• Volunteers spread messages and identified cases for nurses to treat
• Avian influenza preparedness
Additional Activities• MOH requested
urban community mobilization work
• Flipchart produced covering 9 health themes for nationwide distribution
• Mobile caravan performed skits
• Radio spots
Mobile theater group performing a skit
Flip Chart Preparation
Tadjoura district volunteers and community members training in flip chart utilization: Feb 2006
Nutrition for a nursing mother
When to take a child to the health post
Incinerator now available in the 23 project sites for medical waste management
Medical waste situation in 2005
Solar pump installation in Assamo
Infrastructure Rehabilitation
Drilled well in 2008
National Community Mobilization Strategy
• After study tour, MOH formed committee on social mobilization for health policy
• PECSE provided framework for policy
• National Policy promulgated in 2006!– Validated role of Community Health Volunteers
and Health Committees– Created new MOH cadre of Health Aides based
on Ethiopian model
A major step forward
Ass-Eyla health committee members showing their certificates of recognition with pride: April 2008
Results• By late 2006 utilization
rates rose for prenatal care and immunization
• Contributed to positive national results:
The Project social mobilization assistant with the Gallamo female volunteer ‘s child: 2006
2002
2006
Infant Mortality(per 1000 live births)
103 67
Under-5 Mortality(per 1000 live births)
121 94
CPR 12% 18%
Results: Deliveries Proportion of Deliveries in PECSE intervention health facilities
0
10
20
30
40
50
60
70
Alisabieh Arta Dikhil Obock Tadjourah Average
PECSE district
Per
cen
tag
e 2004
2005
2006
2007
Results: Antenatal CareAntenatal Care: at least one visit (2004-2007)
50
300
550
800
1050
1300
1550
1800
2050
2300
2550
2800
Months
Nu
mb
er
2004
2005
2006
2007