TTM Trained Traditional Midwife VDC Village Development Committee VPD VHW Vaccine Preventable Disease Village Health Worker Executive summary The overreaching goal of Liberia’s health and social welfare sector is to expand access to basic health and social welfare services of acceptable quality and establish the building blocks of equitable, effective, responsive and sustainable health and social welfare services service delivery system. This goal is measured by the attainment of two critical targets: reduction in the number of maternal related deaths by 10% and reduction in number of deaths in children under age five years by 15%. The Basic Package of Health Services established by the Ministry of Health and Social Welfare has been successfully rolled out throughout the country and evidence indicates that the health status of the population is improving. However, maternal and child mortality remain high and major killers like malaria and diarrheal disease continue to be among the most common illnesses, while new diseases reflecting changes in lifestyle and diet threaten the population. Despite the success of the Basic Package of Health Services, the public facility network continues to leave out a large proportion of the population living more than one hour walk from a health faculty. The health system workforce lacks the right mix of skills, and it should deploy according to service delivery needs. Skilled providers should be retained where they are needed most. Resources allocated for service delivery in both urban and rural areas do not closely reflect the size of the catchment population and facility workload. Referral linkages between the various levels of the system do not function well.
Annex 1: Community Health Services Strategic Work plan: No Expected Results Strategies Activities Main targets Indicators Phase of implementation A. STRATEGIC OBJECTIVE 1: To build capacity and strengthen Communities to support the delivery of EPHS at community levels 1 Partners / Stakeholders and communities are actively using MOHSW national policies and strategies in planning and implementing community-based activities Make available all the necessary documents (e.g. Policies, guidelines, training manuals, treatment strategies, supervision and monitoring tools etc) Finalize, print and distribute the Revised Community Health Services policy and strategies CHSD,CHTs, Partners , stakeholders # of partners Stakeholder, CHTs, working in line with the National community health services and polices January –June, 2012 Conduct regular monthly/quarterly coordination meetings and supervision CHSD,CHTs, Partners , stakeholders CHVs, communities donors, # of monthly/ quarterly review coordination meeting minutes and supervisory reports 2011-2015 2 Community Health structures in 88 health districts in 15 counties Re- activated or established Re-activated or structured all communities in 88 districts are to fully participate in community-basd activities 1. Conduct advocacy/sensitization meetings in communities District commissioners, paramount, clan and Town chief, youth, women and civil society groups # of advocacy/sensitization meeting held and minutes available 2012-2013 Conduct training on the community health services policy and strategy CHC, CHDC, CHV # of CHC, CHDC, CHV trained 2012-2013 Conduct monthly coordination meeting # of meetings and minutes 2012-2015
3 Planning, implementation, supervision, monitoring and evaluation is Coordinated and improved establish coordination mechanism for proper planning, implementation, supervision, monitoring and evaluation of community based intervention Attendance listing Conduct partners mapping in each county # of partners in each county strengthen the mechanism for supervision and monitoring of activities at community levels Conduct Monitoring visits Conduct Joint monitoring and quarterly supervision CHSD,CHTs, Partners , stakeholders CHVs, communities donors, 2012-2015 # of reports from joint quarterly supervision and monitoring visits CHT, CHVs, Partners # of monitoring visits and available reports B. STRATEGIC OBJECTIVE 2. To raise awareness of community members to implement preventive health interventions (for the selected public health programs) by providing them with the necessary and appropriate information, and making the commodities and/or services available (where applicable). 1 Households and/or individuals are practicing/ implementing preventive health measures for the selected public health programs Build capacity of households and/or individuals to practice/ implement preventive health measures for the selected public health programs Training IEC/BCC material production and distribution Airing of health message on local Radio Stations House to house health talk, Group discussion on community health issues CHVs, community members # % of households and/or individuals practicing/ implementing preventive health measures for the selected public health programs 2011-2015 2 Incident of malaria related morbidity Empower communities all community member including Create awareness on the use of ITN Community members Pregnant women % of community members sleeping 2011-2015
and mortality reduced pregnant women and children under five sleep under ITN overnight Make ITN available in all communities Implement IRS activities in communities CHVs Health workers under ITN every night 3 Incident of malaria in pregnancy reduced Ensure every pregnant woman take IPT 2 before delivery Create awareness on the use of important of IPT Make IPT available in all health facilities and communities Community members including pregnant women CHVs % of pregnant women having IPT2 (not less than 80%) by 2011-2015 4 Number people doing voluntary testing increased Create awareness on the use of important Reaching many persons with information on voluntary testing and counseling Create awareness on the use of important voluntary testing Make testing centers accessible Community members including pregnant women CHVs % of increase in the coverage of voluntary testing 2011-2015 5 Immunization coverage increased -Full Immunization for all children under one year -Reaching every children under one year of age using the RED Approach. -Routine Immunization -Create awareness on the use of important of Immunization -Implement RED strategic approach CHVs, Community members, Health facility staff Immunization Coverage increase to 85% with pent-3 2011-2015 Child and maternal mortality reduced -Reaching every children under one year of age using the Reaching Every District(RED) Create awareness Community health volunteers, Community % of reduction in child and maternal mortality achieved 2011-2015
6 Approach -Reaching every pregnant woman using the REP approach. members, Health facility staff 7 DOTs coverage increased Referral of all suspected TB cases to health facilities, tested and positive cases put on treatment Create awareness Train CHVs Make testing centers accessible Community members, Health facility staff CHVs % increase in DOTs coverage 2011-2012 C. STRATEGIC OBJECTIVE 3: To provide prompt and appropriate treatment to patients within 24 hours of onset of symptoms of infections (for selected diseases). 1 Complications and mortality in under fives is reduced -All cases detected or presented are given prompt and effective treatment within 24 hours -Training of gCHVs in childhood diseases (malaria, ARI and Diarrhea -Create awareness -Train gCHvs in using RDT -Create awareness on gCHVs Caregivers, CHVs Health facility staff % of cases (detected or presented) is given prompt and effective treatment within 24 hours of onset of symptoms 2012-2015 2 Suspected or presented cases confirmed before -All suspected cases that are detected or presented benefited from Parasitological diagnosis gCHvs caregivers % of suspected cases that are detected or presented benefited from Parasitological diagnosis 2012-2015
confirmatory diagnosis before treatment. -Create awareness to discourage self treatment treatment (eg malaria (e.g. using RDTs in the case of malaria) mothers and fathers (e.g. using RDTs in the case of malaria) - Strengthen the mechanism for supervision and monitoring of Community activities. -Diligent, timely supervision & mentoring of gCHVs to ensure quality of service. CHT, partner sup. Team # of gCHVs performing RDT correctly. (Supervisory report) 2012-2015 3. Ensure the availability and Access to quality medicine and other commodities (in the community for CCMP.) Make available adequate supply of RDTs medication for CCM of Malaria NMCP, & Partners gCHVs & community target pop Commodity Monthly report (report will reveal stock out) 3 Increased malaria, ARI, TB, diarrhea case detection 5. Establish a well functioning community based surveillance system. Conduct baseline and follow up survey MOH & partners # of baseline surveys conducted and analyzed 4 severe disease cases referred within 24 hours of detection or presentation Prompt referral of all severe disease cases for appropriate management within 24 hours of detection or presentation -Training of gCHVs -Create awareness for caregiver and community members gCHvs caregivers and community members % of severe disease cases are referred for appropriate management within 24 hours of detection or presentation 2011-2015
D. STRATEGIC OBJECTIVE 4: to establish a functional community-based surveillance system 1 A functioning community-based surveillance system is in place Revised community health policy to include Surveillance strategies, -Consultative review and finalize the Community Health Policy and strategy Documen -Produce and distribute community HMIS register CHSD, EPI, M&E Unit, Partners ,CHTs # of meetings held and minutes % of communities covered by HMIS 2012-2015 2012-2015 -Roll out HMIS training at county, facility and Community levels # of CHVs, CHCs trained in disease surveillance reporting 2012-2015 2 Cases of the different diseases under surveillance reported at community level Institute Community disease data base at all levels Community meeting to create awareness on community opinion leaders CHSD, EPI, M&E Unit, Partners ,CHTs # of community meeting held and documented 2012-2015 D. STRATEGIC OBJECTIVE 5: To secure (ensure) the commitment and participation in CBI among partners/stakeholders at all levels of the health delivery system including the community level.
1 and communities are actively involved in securing required resources (human and financial) for Community Based Initiative planning and implementations. Ensure Partners/stakeholders and communities are actively involved in securing required resources for Community Based Initiative planning and implementations Mobilize resources by developing and submitting project proposals International Partners, Donors and UN Agencies # of Donors / partners contributing to CBI 2012-2015 2 Increase in financial resources from the partners committed to disease control Mobilize financial resources and ensure it is committed to disease control Meet with partners, donors regularly plan community-based activities together International Partners, Donors and UN agencies Amount of funds available for CBI 2011-2015 3 Coordination for planning, implementation, supervision, monitoring and evaluation Conduct regular coordination meetings are held Conduct regular monthly/quarterly coordination meetings International Partners, Donors and UN agencies # of meetings and minutes available 2011-2015 4 All partners reporting regularly (e.g. quarterly) to the division of Community Health Services Collect regular reports from all partners Make available reporting tools Collect report quarterly International Partners, Donors and UN agencies # of partners reporting regularly 2011-2015