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Changing community health practices to improve use of facility services to treat fever in under-fives in the Lake Zone, Tanzania
Since 2011, the Tibu Homa Project (THP) has worked to improve case management of children under five years of age with fever in the Lake Zone (Kagera, Mara, Mwanza, Geita, Shinyanga, and Simiyu regions) of Tanzania. The Lake Zone was identified by the Ministry of Health and Social Welfare (MoHSW) and the United States Agency for International Development (USAID) because of its high under-five mortality rate, above the national average, and a high prevalence of malaria. To complement and support government efforts to reduce morbidity and mortality of under-fives in the Lake Zone, USAID launched project, which is led by University Research Co., LLC (URC) working in partnership with Amref Health Africa and Management Sciences for Health (MSH).
Over the past two years, the Tibu Homa community component, implemented in partnership with the Regional and Council Health Management Teams (RHMTs and CHMTs) and other community and faith-based organizations, has made progress towards changing community health practices to improve the use of facility services to treat fever in under-fives in Mwanza, Mara, and Kagera regions. The project and its partners have focused on increasing linkages between health facilities and communities to both improve the use of health services to treat fever in under-fives and to create sustainable and effective linkages between health facilities and the communities they serve, hence contributing to reducing under-five morbidity and mortality due to febrile illness, which is high in the Lake Zone compared to other parts of Tanzania (NBS and ICF Macro, 2011).
Tibu Homa reviewed, identified, and documented community structures, partners, and networks working on community approaches to care for under-fives in Geita, Nyamagana, Sengerema, Muleba, Misenyi, Tarime, and Musoma rural districts. Based on the findings of the review, the project has worked to improve linkages between health facilities and the communities served through the formation and/or revitalization of Village Health Committees (VHCs) that implement monthly community awareness activities to promote timely care seeking behaviors. The project used the standard integrated community maternal newborn and child health training package to train community health workers (CHWs) and their supervisors (CHWs). Furthermore, the project has conducted quarterly Village Health Day (VHD) events and monthly outreach services jointly with local leaders, CHWs, community-based organizations (CBOs), and health facility quality improvement teams. Information, education and communication materials were disseminated during those events, and monthly community supportive supervisions and data collections were carried out.
Results obtained from project implementation to date include:
- 83 revitalized VHCs have organized monthly plans and promoted early care-seeking behavior activities.
- CHWs and their supervisors met monthly to review progress and planning of activity implementation.
- 166 trained CHWs conducted 1,936 household visits to provide health education that resulted in 192 children being referred to health facilities.
- Monthly joint outreach services with health facilities that included diagnosis and treatment of under-fives with fever contributed to 18.6% of under-fives being brought to the catchment health facilities and seen by a skilled health provider within 24 hours after onset of fever.
- Community sensitization resulted in 41.7% of under-fives being brought and seen by the catchment health facility’s skilled health provider within 24 hours after onset of fever during October 2013 to July 2014 quarterly VHD events.
- To improve collaboration, an inventory of 94 CBOs that provide services for under-fives has been developed for collaborative work with other USAID partners.
Success towards changing community health practices to improve use of facility services to treat fever in under-fives requires collaboration between policy makers, skilled health care providers, and families, with support from their communities (UNICEF, 1999).