This is Bill Brieger, again, to wrap up our session on Community in Health Systems and Community Systems. I want to thank you for being with us during these various sections, and hope you'll be able to apply some of this. We're going to talk a little bit about the lessons. Ideally, we would like to have feedback from you during this type of discussion, but we're, want you to turn on your, put on your thinking caps and think about things as we go through this final wrap up. One thing that's important, as we mentioned before, is that the tools we have described are some of many, many, many tools. And we want you to be creative, to go online, to look for other organizations that have community work, and see what kind of tools they're using. See if you can figure out what are some of the theoretical underpinnings that are guiding these tools. The things we talked about. Do the tools take advantage of the community social networks? Do the tools take a participatory or involvement approach? Do the tools come in with expert planning? Or do they rely on locality development. So we want you to be looking for more of these tools. We want you to think about, especially as you're working through the assignments, and the case studies we'll be providing you. Of community capacity, and how application of certain tools help the community capacity change, or if it didn't, why not. For example, the care groups, as I mentioned that was described to you in the human resources lecture, emphasized change in leadership, the community directed interventions. Sought to bring about change in access to resources and community management skills. The community coalitions were clearly geared toward improving networking, building on the social networks and social capital in the community. The rapid and participatory rural appraisal. Skill involved problem solving skills. Identifying needs, identifying resources, and solving problems. So we want you to think about this, especially as you're examining the case studies. what are some of the other changes in community capacity that occurred, why did they occur, which tools are the most helpful. Clearly we have two, I wouldn't say completely contrasting, issues involved when we're talking about the community. But one of the concerns we have is the program that we're working for and its goals versus long-term community development, community ability to tackle and solve problems. So, including the care-group approach, we've looked at five different tools that have addressed some sort of health or health-related issue. We've looked at Malaria control with care groups and community-directed intervention, there's been HIV issues addressed through the rapid appraisal approaches. Some of these, like the participatory appraisal and the performance partnership defined quality approaches are a bit more open ended. They can encourage communities to think more broadly about improving their situation, and some are more focused around specific health issues. But ultimately we need you to think carefully about who sets the agenda for health and development. And what is the relationship of the community to the health system? These are key issues. Is it a partnership? Or is the health system instructing the community what to do? In comparing the different tools, we also want you to think not just of the community, but as yourself. Of yourself as a change agent in the community coalition approach. What type of change agent is required? I filled in this first little box. The person needs to be a facilitator. Think about this, what about the community directed intervention approach. Does this require an expert, a manager? What about care groups? What do you remember from that lecture. Were the people facilitating? What kind of approach did they take? And again, examine this in terms of thinking about the long term implications. As the change agent, as the person coming in to help the community, are you actually helping them to bring about change and improvement in their lives on a long term basis. Or are you simply bringing about enough change so you can meet your, the goals of your funding partners? What level of participation and involvement can we achieve with the different tools? With community coalitions, can we achieve. Involvement. Can we achieve community directed, community control? What we're seeing is that the coalitions may have been initially formed or encouraged by the health system, but then ultimately the coalitions can do advocacy to bring about how systems change. The community directed intervention started with just one particular health problem, onchocerciasis, but what we've learned is that the community working in partnership with the health system can handle a number of commodities. There may be some challenges in terms of socially sensitive issues like TB or leprosy, but in general the community can do a lot, so what level can be reached through that? The partnership defined quality with its quality improvement teams, bringing together the health system and the community, or also in the case of Nigeria the education. agencies in the community, by bringing them together to solve problems, what can be achieved. Again, the facilitators for rapid appraisals may come from the outside, but what happens next? Definitely, learning occurs when the community starts to interpret its own mapping. Starts to interpret the power relationships, starts to interpret the location of resources, the access to resources. What about the care group? How far can we go with that? We definitely need supportive supervision from the health system. How far can these groups go? Toward involvement and long-term sustainability. This is the kind of critical thinking that we would like you to do as a result of this session. And as we said before, it's important to combine tools and approaches. We mention the World Bank program in our community-directed interventions with malaria and pregnancy. having observed what we were doing in Akwa Ibom State, the bank asked Jhpiego to work with the other states there, they have in their program. To train them on how to use the community directed approach for malaria. And what they call the malaria plus package. This includes community case management of diarrhea, promotion of immunization, treatment of pneumonia. And also they're concerned about using our community coalition approach to work with the different health facilities. So this combined approach of three different interventions is seen as valuable to ensuring that the malaria booster program reaches the people in need. So again, there's no one tool that could solve all the problems. So how can you creatively combine them? In the longer term, we're concerned about which tools will lead to sustainability. Where the community controls and directs the nature of the program, where the community is in partnership with the health system and other development resources and community is the one that brings them in to work together. So, the question is, what mechanisms will help us link the health system in a seamless manner so that the household and the health facility are of a same mind, that we have a health facility, like we had the Antenatal Clinic without walls. That the whole community, including its health facilities, is the health system. [MUSIC] [MUSIC] [MUSIC]
