Community-directed interventions for priority health problems in Africa: results of a multicountry study

Objective To determine the extent to which the community-directed approach used in onchocerciasis control in Africa could effectively and efficiently provide integrated delivery of other health interventions.Methods A three-year experimental study was undertaken in 35 health districts from 2005 to 2007 in seven research sites in Cameroon; Nigeria and Uganda. Four trial districts and one comparison district were randomly selected in each site. All districts had established ivermectin treatment programmes; and in the trial districts four other established interventions - vitamin A supplementation; use of insecticide-treated nets; home management of malaria and short-course; directly-observed treatment for tuberculosis patients - were progressively incorporated into a community-directed intervention (CDI) process. At the end of each of the three study years; we performed quantitative evaluations of intervention coverage and provider costs; as well as qualitative assessments of the CDI process. Findings With the CDI strategy; significantly higher coverage was achieved than with other delivery approaches for all interventions except for short-course; directly-observed treatment. The coverage of malaria interventions more than doubled. The district-level costs of delivering all five interventions were lower in the CDI districts; but no cost difference was found at the first-line health facility level. Process evaluation showed that: (i) participatory processes were important; (ii) recurrent problems with the supply of intervention materials were a major constraint to implementation; (iii) the communities and community implementers were deeply committed to the CDI process; (iv) community implementers were more motivated by intangible incentives than by external financial incentives. Conclusion The CDI strategy; which builds upon the core principles of primary health care; is an effective and efficient model for integrated delivery of appropriate health interventions at the community level in Africa

Cost Recovery at Health Facility Level : Discussion paper

In analysing and discussing the four studies; the criteria for assessing financing mechanisms adopted by Anne Mills and Lucy Gilson; both at London School of Hygiene and Tropical Medicine; were used. Their criteria cover various issues such as: efficiency in raising and using resources; equity concerns; demand for health services or consumer behaviour; supply of health services and provider behaviour; displacement effect; and social and political acceptability

Sustinability of Community Health Care: The Community Health Financing Approach of Pallisa Community Development Trust (Pacodet)

Background: PACODET is a community generated and controlled trust formed in 1989 to promote primary health and environment care (PHC/PEC) in a population of about 60;000 people in the ten neihgbouring parishes in the five sub-counties of Kibale; Kameke; Agule; Putiputi and Butebo in Pallisa district of Eastern Uganda. The project area is generally a flat wooded savannah plain interspersed by low granite rocks with extensive encroached woodlands and etlands. this area was intensively hit by isnecurity in 1987. The tribes Iteso and Bagwere live in the area. they are subsistence farmers growing legumes and tubers as the main food crops. Rice and cotton are grown as cash crops. People are generally poor; education status is poor and communciation systems are lacking. Major diseases affecting people are malaria; respiratory infections and diarrhoea. Before the project was started and the nearest health unit - Pallisa hospital - was over 20 miles away. Illness among mothers and children was frequent. This led students and people in Kapuwai to initiate the PHC/PEC project.Objective of Paper: This paper presents an overview of the PACODET Community financing of PHC/PEC project. Specific areas covered in this paper include organisation; health activities carried out; resource mobilised; management; and lessons learnt since 1989

Case Studies of NGO CBHC/PHC Programmes: Perspectives on Community Participation and Health Care Financing Initiatives : A Comparison of the Kasanga CBHC and Mission Mouving Mountains CBHC Programmes

"Background: In 1992; the Minsitry of Health requested for a study of five known ""good"" CBHC/PHC programmes; with a view to help planners in the Ministry to develop policy guidelines for the implementation of PHC in the country. Case studies were carried out of five NGO programmes in the districts of Kasese; masaka; Mbale; Pallisa and Arua. Two of the most successful programmes; started with external assistance; are compared to highlight their community participation and health care financing initiatives; and the prospects for control and sustainability of community action. The objectives was to analyse strategies and identify contributing factors for successful implementation of PHC in the country; and to gather and analyse information about PHC in Uganda that would be of use in formulating national policy guidelines for implementation of PHC at district levels and below."

Community participation and Financing Initiatives : Discussion Paper

Provision of health care services has been shared between Government and private institutions (both individual and organisations; mainly churches). The Government generally has established its own practice for sharing responsibility of resource provision between the public and community and other sources; such as national non-governmental organisations and international support. While shared responsibility is important for the overall resource provisions during cut backs from one source; such as Government; the community participation is also potentially creating a community spirit providing support in less measurable areas such as resource mobilisation and utilization

Cost Recovery at Health Facility level: Discussion Paper

Introduction: In the last 35 years; development has occurred in the health sector in almost all developing countries; especially sub-Saharan countries. Access to quality care is the desire of health providers and consumers. Provisions of services often goes with financing them. But who is to do it? Different studies have tried to address this question in other settings. However; none have come out with concrete answers. Alternative health care financing mechanisms have become a subject of great interest as a result of failure of central governments to provide adequate funding for the health sector. Of course reasons for this failure have been established. In the Ugandan context; there were external factors such as the global recession; fall in coffee prices; the debt crisis; and internal factors including the political strife; drought and famine; unchecked endemic malaria and tuberculosis. The emergence of AIDS was an insult to injury. There were also internal allocation inefficiencies; and poor utilities of the available meagre resources. The popualtion has also been growing unmatched with social services. All these have happened. So what next? The available options have been to raise more resources for health services and better utilization of what is available. The papers presented address the user charge option. This is one way of involving consumers in financing their health services again under high government subsidy. But how stable and reliable is the government on subsidizing services? Of course the government is committed to supporting health services; but it is always limited by the overwhelming social and economic demands on its resources; hence the need for consumers to contribute something to supplement its efforts