1. Community Organizations
Key Component of Primary Health Care
in Developing Countries
• Part 1. Overview, Needs, Possibilities
By Paul Freeman
• Part 2. Community Learning Organizations, in Rural
Mozambique facilitated by ADRA
By Sonya Funna Evelyn

2. Part 1 Overview Needs Possibilities
• Currently many projects with a community level content fail
to be sustained post project
• Many possible reasons- lack of local ownership, pace, resource
maintenance- personnel, equipment & consumables, technical
quality
• Reality communities live with a full range of problems at the one
time- NOT just those in a particular project
• Evidence based approaches good but evidence may come from
ideal - effectiveness versus efficacy studies. Local cultural aspects
maybe VIP but how about “common sense”
i.e real consultation, a real active role in one’s own life,
self esteem, unique contribution, motivation, ownership.

3. Community Health Needs if these were
expressed in programs (Universal HC)
• Maternal, Neonatal and Child Health
includes, antenatal, birth, postnatal, resuscitation of newborn, nutrition of mother and
child, family planning, iCCM + ITNs, EPI mother & child, adolescent health.
• Early emotional development of children
• Water and Sanitation
• STIs including HIV/AIDS.
• Early detection of epidemics, collection of vital statistics
• NCD prevention and adult nutrition
• Diabetic management, tobacco control
• First aid for trauma
• Mental health
• Supervision of TB treatment
• Disability management
• BCC in association with many of the above.
• Monitoring system to report activities in most of above.

4. Sustainable Development Requires Action
Learning
• “Development can be neither given nor
received; it must be generated from within.”
• “What the less developed have been most
deprived of is not the fruits of development,
but the opportunity to develop themselves.”
•
Ref: “Systems Thinking” Jamshid Gharajedaghi

5. Interest
groups
Policymakers,
planners
Managers,
providers
Communities,
households
MIS
Evaluations
Research,
pilot projects
The “Blueprint” Strategy
A fundamental flaw
Health
Learning Action
Project
Blueprints
Disconnects
learning from
action

6. Policymakers,
planners
Managers,
providers
Communities,
households
TasksCompetencies
Health System Development -
“Learning Organization” Strategy
(H.Moseley)
Interest
groups
Learning
Health
3
1
2
Adapted from Korten, 1980

7. Some Characteristics of a Learning
Organization
• Common Vision- healthy community.
• Team Learning- together we can master
• An appreciation that the different members of the group contribute different
skills and capacities. Technical expert help is needed but community members
contribute knowledge and skills that health professionals cannot.
• Personal Mastery-personal capacity growth sought and
nourished / motivation ( inner purpose- after Pink “Drive”)
• Mental Models – we can do this.
• Move away from passivity

8. Community Based Organizations
Definition – a community organization established by a community
(with initial and limited ongoing facilitation) bringing together
community leaders and all types of community “health” workers in
the community.
Ideally includes cross- sectoral workers.(Nepal)
Facilitators could be NGO personnel but why not train a small Cadre
within MOHs to do the same?

9. Properly Facilitated What Can Community
Based Organizations Do?
• Plan local community health activities
• Deal with local health problems as they arise
• Together divide up community program needs into manageable work for CHW group
members
• Continue to learn together-e.g from one another & local H.Center
• Monitor and Give feedback to one another and the local Health Center. Connection with local
H.Center/ Good facilitator VIP
• More capable workers train less capable
• Recruit new workers, motivate one another.
• Meet health needs at the household level
• Identify and Reach those that Health Center staff cannot
• Identify suitable compensation (not necessarily $$s) for those more skilled workers (such as
providers of iCCM) who must work longer hours
• Integrate other health related activities-e.g agriculture, school ed

10. Mozambique Talking Time

11. Part 2 Community
Learning
Organizations, in Rural
Mozambique
Part of Health Component of
OSANZAYA Multi Year Assistance Program
Zambezia Province 2009 -2013
facilitated by ADRA

12. Mozambique
- Centuries of Portuguese Colonial neglect
- Decades of Marxist economy
- 30 years guerilla war
- 1990 multi-party political system, market
based economy, free elections
- 1994 first democratic elections
- Pop 25.2 million
- Life Expectancy 50.15
- Annual per capita income $424
- Low investment in education
- High adult illiteracy
- Low agricultural productivity
- Limited economic opportunities
- High underemployment
- Poor infrastructure

13. Osanzaya Zambezia
- 5 year USAID funded TTII
project
- 5 districts of Zambezia (Ile,
Pebane, Maganja da Costa,
Mocuba and Lugela)
- Income $100/year
- Agriculture main economic
activity
- 50% of adults > 19 years old
illiterate
- Many communities over 20 miles
from nearest health center

14. Osanzaya Zambezia
Goal: To Reduce Food Insecurity in Targeted Five Districts in Zambézia
Province.
• SO1: Improved Income Growth of 37,500 Rural Beneficiaries
By integrating marketing, increased productivity, and
strengthened value chains of select agriculture products (peanuts,
maize, cow peas, sweet potato and commercialization of cashew nuts).
• SO2: Improved Health and Nutrition Status for 40,000 Beneficiaries
By improved health and nutrition status of children under five, improved
hygiene behaviors, access to sanitation solutions, and adequate clean
water. ( some of SO1 agricultural products to be used in improving child
nutrition)
• Literacy & Disaster Preparedness (ADPP & Samaritan’s Purse)

15. Overall Activities
• Established and strengthened Community Leadership Councils
• Established mothers’ and fathers’ groups
• Cooking/feeding sessions
• Constructed and rehabilitated boreholes and wells
• Constructed household and community latrines
• Monthly GMP
• Participatory Hygiene and Sanitation Transformation (PHAST)
• Behavior Change Communication
• hygiene, diet diversification, food preparation, breastfeeding, disease
prevention, health-seeking and caregiving behaviors

16. Community Leadership Councils
• Community leadership/elders
• Community health volunteers (1
per 15HH)
• Hygiene promoters
• Mothers’ and Fathers’ group
leaders
• Water Well Committee members
• C- IMCI workers
• FP/STI counselors
• Home-based care workers
• Midwives
• Traditional birth attendants
About 25 members and they include:

17. • Meet at least every two weeks
• Mitigate health issues in communities including in emergencies
• Receive feedback and reports from all CHWs of their activities
• Representatives (2) meet with local HC staff once a month
• Identify community members with special needs
• Usually done via group counseling sessions and household
visitation
• Supervised by project staff who would meet with CLCs daily or weekly
Community Leadership Councils

18. • Nutrition
• Basic nutrition package
• breastfeeding , promotion of Vitamin A rich foods, complementary feeding, food
groups and balanced diets
• Preparation of enriched porridge- to give variety of food
• Growth Monitoring
• Caring for the malnourished and referral
• Sickness
• Prevention of malaria, diarrhea, cholera and HIV
• Initial care of the sick child
• Prompt referral of the sick child to the nearest health facility
• Home Based Life Saving Skills (HBLSS)
Community Leadership Councils Training

19. • Reproductive health
• Family planning
• Child spacing
• General health
• Hygiene
• Sanitation
• Environmental health
• Caring for the needy
• Orphans and vulnerable children
• Basic Organization
• Planning
• Problem solving
• Referrals
Community Leadership Councils Training

20. KEY FINDINGS
Figure 1. Decrease in Portion of Severely
Malnourished
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
Baseline
(2008)
2010 2011 2012 2013
% of participating children aged 0-23.9 months with weight-for-age z-
score <-2
% of participating children aged 0-23.9
months with weight-for-age z-score <-
2

21. KEY FINDINGS
INDICATOR BASELINE FINAL DIFFERENCE
% of children less than 24
months with diarrhea in
the past 2 weeks”
33.8% 28.6% 5.2%
% of caregivers and food
preparers using
appropriate hand-washing
behavior
56.9% 80.6% 23.7%
% target population using
latrines
29.4% 53.8% 24.4%
% target population with
year round access to
improved water source
23.3% 56.70% 33.4%

22. Key Findings
Indicator Achievement
Number hygiene promoters trained 4,222
Number caregivers trained in HH hygiene 62,164
Number of caregivers trained in health and nutrition topics 53,252
Pit latrine slabs distributed 3,900
Community leadership councils formed 193
Community health volunteers trained 2,850
Mothers’ and fathers’ groups established 190

23. Thank You! Mozambique Dancing Time