1. Introducing Community Health Agents
to accelerate achievement of MDGs 4 and 5
in Tanzania:
The Connect Project
The Role of the CHA intervention in
Community-based Primary Health Care

2. Core Aspects of the CHA Role
1) Improve household and community practices and
capacity to support maternal and child health and child
development.
2) Enhance community-based case management of
childhood illnesses when illness/injury does not require
facility attendance.
3) Strengthen the health system by way of facilitating
accessibility of drugs and supplies where needed,
improving organization of work from the community-
level up, including monitoring, supervision and
referral.
Training Module on IMCI and
Community IMCI Implementation, MoH
Tanzania, 2004
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3. Household and Community Practices
Routine household distribution of key household health
“technologies” that prevent illness
• Insecticide treated bednets
• Condoms
• Oral contraceptives (use of DMPA-Uniject under
negotiation with PATH)
• Soap and hygienic supplies

4. Household and Community Practices
Education and counseling regarding key aspects of
reproductive and child health
• Child growth, development and management of
illness
• Nutrition (including micronutrient and complementary
feeding)
• Water, sanitation and hygiene
• Reproductive health
• HIV/AIDS and STI Prevention
• Tuberculosis and malaria prevention
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5. Household and Community Practices
Pregnancy monitoring visits during antenatal period
• Promotion of antenatal care and facility-based delivery
• Counseling on danger signs of complications, nutrition
and post-partum family planning
• Birth planning and emergency preparations
• Monitoring and reminders for net use and IPTp, TT and
PMTCT adherence
• Identification and referral for complications
• Promote male active participation and child care and
Reproductive Health

6. Household and Community Practices
Postnatal/partum visits for both mother and newborn
• Counseling on essential newborn care
• Identification and referral for complications
• Promotion of postpartum/natal care
• Identification of LBWs using foot size
• Family planning
• Monitoring/reminders for early diagnosis of HIV
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7. Community Case Management
Training in CHAs in Integrated Case Management
• Ability integrate disease specific guidelines into a
comprehensive and efficient process for attending sick
children.
• Understanding of protocols for assessment for
symptoms, and danger signs in sick children.
• Recognition of less common illnesses or chronic
problems that may require clinical care or be managed in
community (routine injuries, etc.)
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8. Community Case Management
Routine Household Visits to Assess U5 Children for
Major Symptoms
• Cough or difficulty breathing, diarrhea, fever, ear problems,
bacterial infection, nutritional, immunization and Vitamin A
status, etc.
• Identification of select clinical signs for classification (not
diagnosis):
• Urgent Referral to clinical level of care
• Initiation of specific treatment using limited number of
essential drugs
• Home treatment, counseling/education of caretakers,
including active participation in treatment of children.
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9. Community Case Management
Provision of complete treatment and follow up to children
with uncomplicated illnesses:
• Malaria – dependent on national supply and scale up of Rapid
Diagnostic Tests (RDT); treat with SP and Paracetamol
• Pneumonia: using ARI timers (detection) and Cotrimoxazole
• Diarrhea: Oral Rehydration Therapy with zinc and extra fluids.
• Malnutrition: Increased breasfeeding, extra feeds (if on
complementary feeding.
• Referral to facility when appropriate.
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10. Local Health System Strengthening
Facilitate Access to Additional Support and Financing
Mechanisms:
• Community mobilization for enrollment in National Health
Insurance/Community Health Funds
• Education and identification of households eligible for fee
exemptions, facilitate their acquisition of CHF cards and care-
seeking support.
• Identification of vulnerable households and facilitate access to
additional support services (e.g. families affected by disability,
aging household members, chronic illness, poor water and
sanitation, etc.)
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11. Local Health System Strengthening
Linking district-level and village planning and
organization:
• Provide organizational support with facility management and
village health committees.
• Represent and encourage involvement of village health
committees for immunization, Vitamin A, ANC, and reproductive
health community outreach.
• Develop and sustain emergency referral mechanisms.
• Communicate district and village health agenda to the community
and ensure accountability
• Participate in maternal and newborn death audits.
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12. Local Health System Strengthening
Improve quality of data on community health information
and reporting mechanisms:
• Training and follow up support to facility-based supervisors for
supportive supervision of the CHA.
• Facilitate the CHA collection, management and utilization of
health data for decision-making.
• Identify and address bottlenecks in the supply chain of essential
drugs and commodities and integrate the community into that
process.
• Reports summary information to village health committees,
encourages communities to advocate for health rights to decision
makers.
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13. Enabling CHA intervention
…generate
sub-system system integrates pillars, links
inputs… outcomes… inputs to impact
Integrated service components: …that alter the
CHA package of services + climate of CHA
emergency referral system Enhanced demand for INTRODUCTION
access: services
Health workforce: Community
…impact on
CHA training, deployment and -based
services health
supervision
behavior, and
Extended Improved ….
Information:
range of equity
Data collection + feedback tools for
services:
CHAs Enhanced
Promotion/
prevention Health
Medicines, Vaccines, etc: Service
Supply chain management for Improved Utilization
essential commodities for CHAs quality of
services: Improve
Financing & social protection: Reduced Improved
People-
Financing of programme + role of
centred social wellness Child
CHA in expanding protections costs and
behavior
Improved
Leadership & governance: efficiency:
maternal
CHAs relationship with local Task- survival
governance structures & planning shifting