Community Outreach

Learning Objectives
Importance of Community outreach Key elements of community assessment

Formulation of community outreach strategy

Considerations for developing and using CMAM messages Preparation for community mobilization and Training

Core Components of CMAM

Components of CMAM
Outpatient care for the management of SAM (OTP)

Community outreach

Inpatient care for the management of SAM

Services or programmes for the management of MAM (SFP) 4

Purpose of Community outreach

Active case finding for early detection and referral Case follow up in the home

Check on a child who is not thriving or responding well to the treatment Learn why a child was absent from a out-patient care follow up session Learn why a child defaulted (defined as missing three out-patient care follow up sessions in row)

Importance of Community outreach to CMAM-1

It helps to ensure that children with SAM are detected early;
- before the onset of medical complications - referred for treatment, leading to better clinical
outcomes and decreased strain on in patient services

Importance of Community outreach to CMAM (cont)

Obstacles to participation in CMAM
Barriers to Access (Role Play) Exercise Overcoming Obstacles to Community participation in CMAM - Exercise

Obstacles to participation in CMAM

Poor awareness Community mobilization is overly broad Referral and admission criteria are not aligned Local medical or cultural traditions do not connect advance wasting or swelling with under nutrition Community mobilization or site selection may have overlooked important gatekeepers Other services at the PHC facility not well regarded Location of the outpatient care site Participation interrupted by seasonal labour
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Barriers to Access: Role Play

Community Worker
Nutrition Volunteer First Neighbour (in community) Husband Second Neighbour (returning on the road)

Outpatient care nurse

Community Assessment-2

The role of community assessment

Barriers, how the community is organized, how undernutrition is viewed, how the new service is likely to be received

What community assessment consists of

Understanding demand and supply

Steps and methods of community assessment

Community Assessment-(Contd)

Understanding demand
Understanding local perceptions and practices to develop a sense demand inhibitors Area of investigation include ; Local disease classification, attitude towards formal health services, other paths to treatment, community homogeneity/heterogeneity

Community Assessment-(Contd)

Understanding Supply
Also involves community level discussions but the assessors also consider institutional and organizational factors at the facility and district levels. Questions include; Who are the likely candidats for casefinding? Where is the supervision of case-finding better situated? How strong or weak are the links between health facility and community? What channels exist to spread information on CMAM, what risks and advantages are associated with each?

Community Assessment-(contd)

Community Assessment Steps

Defining the parameters of CMAM programme District level review to understand the local context Community level review to complete information gathered at district level Beneficiary level discussions to determine perspective, knowledge, vocabulary of SAM

Key Steps in CMAM Outreach Strategy-3

Insights from community assessment
Objectives and nature of the CMAM strategy

Methods of case finding-How the case finding will be conducted;

House to house/ tent to tent case finding Community case finding Passive case finding

Key Steps in CMAM Outreach Strategy- (contd)

Appropriate models to use will depend on;

The level of SAM in the community Community awareness on the signs of SAM Accessibility of homes ; clustered or dispersed Existing networks of outreach workers Time and resources available for training

Whether active case finding is envisioned as permanent or temporary

Considerations for CMAM Messages

The need for standard CMAM messages;
simple, standardized messages, describing the program

Standard CMAM messages Developing and using handbills

Community Mobilization and training

Key actions in community mobilization and training
Reliable communication between health care providers and community Help communities select outreach workers when necessary Train outreach workers Engage civil society partners

Community Outreach
Key individuals in the community:
Promote CMAM services Make CMAM and the treatment of SAM understandable Understand cultural practices, barriers and systems Dialogue on barriers to uptake Promote community casefinding and referral Conduct follow-up home visits for problem cases
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Thank You..