REACHOUT

Reaching out and linking in: Heath systems and close-to-community services

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 Obiettivo del progetto (Objective)

'Countries striving to provide universal health care coverage and achieve the Millennium Development Goals are increasingly implementing close-to-community (CTC) health services. There is a need for health systems to understand the context and conditions in which these services operate in order to realise their potential. Working with some of the most respected and widely quoted close-to-community services we will identify how CTC services can best be delivered and document generic lessons for system development and strengthening. Building on a strong and exciting partnership, we aim to maximize the equity, effectiveness and efficiency of CTC services in rural and urban slum areas of six countries: Indonesia, Bangladesh, Mozambique, Ethiopia, Kenya and Malawi. We will conduct a situation analysis to guide development of research frameworks. This will be adapted and applied to produce a comprehensive inventory of potential constraints for CTC services. This baseline will guide cycles of interventions for service improvement. We will build capacity on three levels: at practitioner level to enable improved service to be delivered; at researcher level to empower the next generation of researchers in health systems; at policy level to enable transfer of research experience into policy, planning and practice. The interventions will be assessed using the framework to find out what works, in which context and why and what can be improved. Our impact on equity, efficiency and effectiveness will be evaluated using a combination of outcome and process indicators and multiple methods. Analyses will include community and policy maker perspectives and elaboration of CTC providers’ voices in health planning. Through conducting a robust inter-country analysis we will build much needed transferable policy and practice recommendations to strengthen CTC services and empower providers, researchers and policy makers.'

Introduzione (Teaser)

Close-to-community (CTC) care is increasingly being implemented in developing countries striving to meet Millennium Development Goals. The approach helps overcome various obstacles to universal access to health care through promotional, preventive or curative health services.

Descrizione progetto (Article)

To realise the potential of CTC, health systems need to be understood in terms of the context and conditions in which these services operate. The 'Reaching out and linking in: Health systems and close-to-community services' (http://www.reachoutconsortium.org/ (REACHOUT)) project is identifying the best means for delivering CTC services. The overall goal is to maximize equity, effectiveness and efficiency in rural and urban slum areas of Bangladesh, Ethiopia, Indonesia, Kenya, Malawi and Mozambique.

Researchers reviewed the literature to establish an inventory of potential constraints or enablers of the performance of CTC providers. They developed an analytical framework to create common methods and tools for country-specific context analyses, in addition to qualitative research and data analysis workshops. These activities highlighted four common areas of concern: supervision of CTC providers, community engagement, referrals from CTC providers to health facilities, and coordination between stakeholders and CTC providers.

This baseline information will be used to advance interventions for service improvements, and build capacity for three stakeholder groups: practitioners, researchers and policymakers. REACHOUT agreed on common methods and tools, and has drawn up a methods manual to support partners in subsequent project work.

A research uptake strategy has also been designed, and partners are mapping the communications ecology and policy environment in participating countries as well as internationally. Advocacy and relationship-building work has commenced to maximise the engagement of policymakers in all project stages. REACHOUT will use a combination of outcome and process indicators as well as other methods to evaluate impact on equity, efficiency and effectiveness.

The project maintains a strong online presence through its website and various social media sites such as http://twitter.com/REACHOUT_Tweet (Twitter), http://www.youtube.com/channel/UCya_QsYU_rnL-Ccy3eEf9pg (YouTube) and http://www.flickr.com/photos/97778400@N08/ (Flickr). Partners have also participated in international conferences such as the Women Deliver conference and engaged in international networks such as the Global Health Workforce Alliance.

Ongoing work will inform transferable policy and practice recommendations empowering the three stakeholder groups. Overall, REACHOUT is generating a better understanding of the factors impacting health services. Project outcomes are slated to deliver needed interventions that will ultimately improve on the use of health systems for better CTC services.