A proposed framework for the implementation of community based health initiatives(CBHI)in the context of reforms in TANZANIA:enabling households and communities to take effective for the improvement of their own health development

摘要

udA team of I 0 local and one external consultants was contracted to review the implementation of CBHI in Tanzania. The objective of the review was to develop a framework for the implementation of CBHI in the districts; in the wake of Health and Local Government Reforms. Specifically, the team set out to review: Conununity Based Management of CDHC (Situation analysis, Planning, Implementation, Monitoring, Evaluation, and Feedback),Community Based Health Information Systems, Community Based Resource mobilization, Community Based Human resource management, Community Based provision of the essential health service package,Community Based Communication Strategy for Health development and behavior change,Community Based Coordination and linkage for health initiatives.ududIn the course of the review, the team visited 11 districts with the aim of identifying best practice in Community Based Health Initiatives (CBHI) in Tanzania. Lessons derived from district experiences were to be included in this framework so as to guide the scaling up of this appro:!ch throughout the country, as a key element of the Health Sector Reform (HSR) process.ududInformation gathering was undertaken through desk review, key informant interviews, and group discussions as well as observation of ongoing activities at National, District, Ward and Village levels. Visits were made to a total of 11 Districts (and 40 villages, 21udWards). A second visit was paid to two Districts to validate the findings and. s s relevance of strategic actions-suggested by the team. Key infonnants and groups interviewed included: District Management Team (DMT), District Health Management Team (DHMT), Ward Development Committee (WDC) members, Village Chairpersons and Executive Officers, Kitongoji Chairpersons, other Village leaders and ordinary community people at Village Assemblies.ududIn general, the Review Team found that CBHI implemented in whole Districts over a long period of time were associated with a series of indicators of improved health status, household health behaviour, and community services.ududIn Mufmdi District, for example, quarterly pregnancy monitoring reports submission increased from 72% to 88%. Maternal Mortality dropped from 900/100,000 in 1991 toud397 in 1993. Child mortality from 107/1000 to 90/1000 live births. Immunizationudcoverage reached 92% in 1990 and stabilized at 80% from 1994 to date. Family Planning acceptance has reached 75% in some villages. Severe malnutrition had gone down from an average of7 to 1 case per quarter in one of the villages visited. The number ofhouses constructed using pennanent materials had also increased eight-fold during the projectudperiod indicating the possibility of an improving economic base. Access to water sources had improved to the level of 80% of households having access to safe water within 30 minutes walk. The villages visited had not experienced an outbreak of cholera for the past three years. In addition, roads to the villages had been improved anmaintained in good condition.ududThere was increased proportion of women in Village committees reaching up to one third (8/20) in some of the villages. These achievements were attributed to the use of participatory approach in planning and implementation of CBHI.ud