Costs of implementing integrated community case management (iCCM) in six African countries: implications for sustainability

Sub-Saharan Africa still reports the highest rates of under-five mortality. Low cost, high impact interventions exist, however poor access remains a challenge. Integrated community case management (iCCM) was introduce to improve access to essential services for children 2-59 months through diagnosis, treatment and referral services by community health workers for malaria, pneumonia and diarrhea. 

This paper presents the results of an economic analysis of iCCM implementation in regions supported by UNICEF in six countries and assesses country-level sclae-up implications. The paper focuses on costs to provider (healht system andd donors) to inform planning and budgeting, and does not cover cost-effectiveness. 

Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment

In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to strengthen African health systems in order to address communicable and non-communicable diseases. The aim of this study was to assess the position of civil society-led community unity home based care programmes (CHBC), which serve the needs of patients with HIV, within this agenda. It examined how their roles and place in health systems evolved, and the prospects for these programmes in national policies and strategies to revitalise PHC, as new health care demands arise. 

Health policy and integrated mental health care in the SADC region: strategic clarification using the Rainbow Model

Mental illness is a well-known challenge to global development, particularly in low-to-middle income countries. A key health systems response to mental illness is different models of integrated health care, especially popular in the South African Development Community (SADC) region. This complex construct is often not well-defined in health policy, hampering implementation efforts. A key development in this vein has been the Rainbow Model of integrated care, a comprehensive framework and taxonomy of integrated care based on the integrative functions of primary care. The purpose of this study was to explore the nature and strategic forms of integrated mental health care ...

Voices on person-centred care

What is person-centred care to a patient, a physician, a nurse, a hospital head of department, an industry representative and a researcher? How do these people, who all have experience of receiving or working with person-centred care, see person-centred care from their perspectives? Short film clips from the University of Gothenburg Centre for Person-centred Care - GPCC. GPCC is an in terdisciplinary research centre, established in January 2010, with the support of the Swedish government's strategic investment in health and care research. Uniquely GPCC has evaluated the effects of person-centred care in controlled studies. This has established that person-centred care ...

People-centred health systems, a bottom-up approach: where theory meets empery

BACKGROUND AND METHODS:

Health systems are complex and constantly adapt to changing demands. These complex-adaptive characteristics are rarely considered in the current bureaucratic top-down approaches to health system reforms aimed to constrain demand and expenditure growth. The economic focus fails to address the needs of patients, providers and communities, and ultimately results in declining effectiveness and efficiency of the health care system as well as the health of the wider community. A needs-focused complex-adaptive health system can be represented by the 'healthcare vortex' model; how to build a needs-focused complex-adaptive health system is illustrated by Eastern Deanery AIDS Relief Program ...

Strategies and incentives for enhancing the application of health impact assessment (HIA) in Nigeria: a view from those who should know

In consonance with the paradigm shift from curative to more preventive healthcare, there has been an increasing application of health impact assessment (HIA) in many developed countries. However, progress towards the integration of HIA into public policy in many developing countries has been comparatively very slow. This article is a primary research to evaluate the barriers and motivational factors; and to proffer effective strategies and incentives for enhancing the application of HIA in health and development policies in Nigeria. Semi-structured questionnaires were designed and primarily disseminated online to a random sample of health and non-health professionals, public service workers, policy-makers ...

Social solidarity and the right to health: essential elements for people-centred health systems

The right to health has been advanced as one of the key elements to creating pro-poor people-centred health systems (Hunt and Backman 2008; Gruskin et al. 2012). However, one of the challenges for realizing the right to health is the seeming conflict between public health utility and the entitlements afforded by a human rights approach to health. This dichotomy begs two sub-questions, both of which have relevance for building responsive health systems.

Modernization and development: impact on health care decision-making in Uganda

Uganda has faced numerous challenges over the past 50 years from overcoming political conflict and civil unrest, to rapid population growth, to combating the HIV epidemic and ever-growing health needs. Women in Uganda have had a major role to play in the health of families and communities. The researchers' purpose in this study, undertaken in rural Uganda, was to

• a) identify a people-centered definition of development,
• b) compare it to the process of modernization, and
• c) investigate how these processes have changed the role women play in decision-making, in areas directly and indirectly related to their health and that of ...

Exploring perceptions of community health policy in Kenya and identifying implications for policy change

BACKGROUND:

Global interest and investment in close-to-community health services is increasing. Kenya is currently revising its community health strategy (CHS) alongside political devolution, which will result in revisioning of responsibility for local services. This article aims to explore drivers of policy change from key informant perspectives and to study perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change.

METHODS:

We conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives, including those ...

Integrated health and community systems strengthening for improved contraceptive access and uptake in Nampula province, Mozambique

As with all types of interventions, the integration of health services demands an adjustment to contextual characteristics, ranging from the burden of disease to society and culture. Thus, in developing countries across Africa, efforts towards the integration of health services overwhelmingly focus on communicable diseases and family planning, and aim to involve existing community structures in the delivery of health services.

Such is the case of the USAID-funded Strengthening Communities through Integrated Programming (SCIP) project in Nampula province, Mozambique. This project, implemented from 2009 to 2015 by Pathfinder International and its partners, worked to increase access to contraceptive services by ...