Community Mobilization in
Emergencies
Use of Community Action Cycle Model to
Improve Maternal and Child Health in South
Sudan
Michael Odong1; Morris Ama1; Telesphore Kabore1, Jackline
Mumi1, David1 , Asayehegn Tekeste2
OUTLINE
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Purpose of the intervention
Geographical coverage
Description of the intervention
Process results
Changes in Maternal and Child Health
outcomes
• Innovations
• Challenges and opportunities
Purpose of the Intervention
Aimed at improving RMNCH outcomes through
improved community capacities
Geographical Coverage
• WES: 11 Counties,159 Facilities,
…HHP and …BHCs
• CES: 6 Counties, 198 Facilities,
…HHPs and …..BHCs
The Interventions
• Implementation of a Community Mobilization
approach using the Community Action Cycle
• Provision of Community Based Services
through Home Health Promoters
Intervention (1): Community Action
Cycle (CAC)
Explore Health issues
& set Priorities
Prepare to
Mobilize
Prepare to
Scale-up*
Organize the
Communities for
Action
Evaluate
Together
Plan Together
Act Together
The Intervention (2): Community
Based Services Package
• Home visits
• Individual and
Group
communication
• Active case
findings
The Intervention (2):training packages
for HHPs
Training and Supervision
Training of Home Health Promoters
• Curriculum adopted and approved by
MOH
• It covered 4 modules (child health,
maternal health, WASH and
communicable diseases)
• 5 days training, 60% in-class and 40%
practical in the community
• Training done by Gov staff, supported by
NGO staffs
• Job aid (Counseling charts) is provided to
HHPs immediately after training
Boma Health Committee
• 2 days orientation of BHC on roles,
responsibilities and CAC implementation
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On-job mentorship on use of CAC tools
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Supervision
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Monthly supportive supervision to BHCs by
Community officer
Monthly supervision of HHPs and quarterly
review meeting by BHCs
Supervision guided by standard CAC
checklist.
Quarterly award and recognition, integrating
with health-days
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Process Results (1)
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218 Boma Health Committees (BHC) reactivated
178 BHC developed action plans that are under implementation to address RMNCH
issues with regular documentation/reporting
BHC in 92 facilities BHC work closely with facility management to ensure rightful
amount of drugs are received, documented and properly stored.
Overall increased individual and community collective decision-making on
addressing health issues with concrete actions registered in 72 facilities:
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Latrines constructions,
Waste pits,
Compound cleaning
Regular monthly community awareness meetings
Waiting rooms constructed
Construction of Health Workers houses
Process Results (2), Nzara County
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69 Home Health Promoters (HHPs)
trained and equipped.
• 16 BHCs reactivated
• 15 health facilities
Results:
2500
2000
#of people reached
– 15 out of 16 BHCs were meeting
monthly.
– Updated work plan and documenting
progress in implementation.
– All 16 facilities had latrines, wastes pits
and ensure clean compound all time.
– Monthly defaulter rates for EPI dropped
from over 40% to less than 8%.
– Over 5850 of home visits conducted
within five quarter with each HHPs
making average of 10 visits a month.
– 4789 people cumulatively reached
through group or individual education
in five quarters ( see graph)
People reached with information and
services, following training in Q4 FY14 in
Nzara county
1500
1000
500
0
Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
FY1 FY1 FY1 FY1 FY1 FY1 FY1 FY1 FY1 FY1 FY1
3 3 3 4 4 4 4 5 5 5 5
people reached 0
0
0
0
0
0 491 333 909 11081948
Process Results (3)
Number of clients who received community based
services delivered through HHPs from the two states
50000
45000
40000
35000
30000
25000
20000
15000
10000
5000
0
Q2 FY13 Q3 FY13 Q4 FY13 Q1 FY14 Q2 FY14 Q3 FY14 Q4 FY14 Q1 FY15 Q2 FY15 Q3 FY15 Q4 FY15
Outcomes (1)
Number of ANC 1, ANC 4+ and IPT II
For the two states
16000
14000
12000
10000
8000
6000
4000
Q2 FY13 Q3 FY13 Q4 FY13 Q1 FY14 Q2 FY14 Q3 FY14 Q4 FY14 Q1 FY15 Q2 FY15 Q3 FY15 Q4 FY15
ANC 1
ANC 4+
IPT 2
Linear (ANC 1)
Linear (ANC 4+)
Linear (IPT 2)
Innovations by Boma Health
Committee in Nzara
1.
2.
Fixed meeting date: this
addresses the challenges
of mobilizing BHC
members for meetings.
Open attendance lists:
a chart with lists of all
the members developed
and placed on the wall of
their meeting room at
the facility. Members
register their attendance
by self ticking against
their name.
Challenges
• Not enough supportive supervisions were
conducted,
• Lack of funding to support community actions
• High turn over of staff
• Difficulties maintaining contacts with mobile
communities
• Disruptions in implementation
– Security and safety
– Lack of local NGOs capacity
Challenges (2)
• Less priority in terms of funding are always given
to community activities than facilities activities
• Coordination challenges as national policy to
guide the work of community health workers still
under development
• Weak health systems (lack of HRH and supplies,)
to manage referral from the community
• Routine measurement and data use for
community health services are poorly developed
at national level. Hence data collected at program
level does not reach to national ministry of health