Mibs college

Department of community health.

Community health linkages.
Introduction.

INTRODUCTION

Community health linkages

Introduction and definition of terms
Community: this is a group of people who live together in the same geographical area, share
common ideas, common problems, common language OF COMMUNICATION, common
leadership, common physical address, practice common socio-economic and socio-cultural
activities, have similar religious beliefs and interact together in various activities like burials,
weddings, circumcision events among others.
Linkage- this is a connection between two or more items, individuals, groups, ideas, association.
It is a bond that bring together different individuals for the common cause.
Clinical-Community Linkages- they help to connect health care providers, community
organizations, and public health agencies so they can improve patients' access to preventive and
chronic care services.
Types of community linkages
The linkages identified include:
1. single health care providers. These are commonly private clinics and pharmacies that
help in diagnosis and treatment of the community from various ailments.
2. Health care systems –this is how health care programs and projects are ran in a given
nation from the most junior healthcare services centres to the most senior health care
services centre or facility.
3. Community health care providers. These are the people who offer and provide health
services to the community. These individuals range from community health volunteers to
the most senior specialist.
All These linkages work closely with the following agencies
1. Community based organizations
2. Education institutions. Primary schools whereby projects like nutrition projects ran by
world vision.
3. Non-governmental organizations. These are non-profitable organizations that the
community with health for example USAID that runs the HIV/AIDS PROGRAMMES.
4. Agricultural institutions. they include world food programme that controls agricultural
worldwide. It ensures there is sufficient food to feed the all the nations all over the world
from world agricultural rich countries.
5. Public health amenities and facilities- these include public hospital, free medical by the
gvt hospitals.
Creating sustainable, effective linkages between the clinical and community settings can improve
patients' and clients access to preventive and chronic care services by developing partnerships
between organizations that share a common goal of improving the health of people and the
communities in which they live in. These linkages connect clinical healthcare providers,
community organizations, and public health agencies.
The goals of clinical-community linkages include:
1. Coordinating health care delivery, public health, and community-based activities to
promote healthy behavior.
2. Forming partnerships and relationships among clinical, community, and public health
organizations to fill gaps in needed services.
3. Promoting patient, family, and community involvement in strategic planning and
improvement activities.
4. Promoting easy access to health care services for example which are provided for when
need arises.
5. Building trust between community and health care providers.
6. Bridging the gap of attendance between the community and health care givers.
7. The community is put at a position to speak up the issues affecting them including family
planning, maternal mortality, traditional birth attendants, diseases emergence , home
based and waste disposal
8. It helps the community ease the burden of referral through clinical links.
9. Putting in place Strategies that improve access to clinical preventive services (such as
screening and counseling), community-level activities, and appropriate medical treatment
have been shown to reduce and prevent disease in communities.

10. Bringing Collaborations between clinical, community, and public health organizations
like public hospitals, public research which offer a win-win scenario for participating
organizations, clinical teams, community health volunteers, ngos and patients.
11. Community programs get help in connecting with clients for whom their services were
designed.
Types of activities involved in clinical-community linkages include
a. Coordinating services at one location for example cancer screening medical camps,
b. coordinating services between different locations e.g linda mama services that cater for
antenatal clinics, cwc, postnatal clinics and family planning services,
c. Developing ways to refer patients to referral resources through monitoring and
evaluation.
Effectiveness of clinical-community linkages.
1. Patients get more help in changing their unhealthy behaviors.
2. Clinicians get help and exposure in offering services to patients that they cannot provide
to themselves.
3. Community programs get help in connecting with clients and patients for whom their
services were designed.
4. Patients understand their rights more on services they should get from the healthcare
providers.
Services brought closer by community linkages

These services include:

1. Community oral health services.

2. Maternity and mother child health services.
3. Immunization services
4. Screening services
5. Cleft lip collection surgery.
6. Malezi bora and deworming services.
All these services can be offered in the hospitals and public health amenities but the clinicians
and other health care providers make a decision of bring them to the community in an action of
linking the community with health care providers.

Health- this is the state of being physically, mentally, socially and spiritually, it is not the mere
absence of diseases, deformity or any infirmity.

Community health needs assessment

What is a Community Health Needs Assessment?

A Community Health Needs Assessment (CHNA) is a systematic process involving the

community to identify and analyze community health needs.

The process provides a way for communities to prioritize health needs, to plan and act upon
unmet community health needs. Methods for conducting an assessment, but generally include:

 Stakeholder meetings
 Community focus groups
 Surveys
  Interviews with community leaders and members
 Population health and other health-related data
 Diseases surveillance data

The top needs across in Kenya for the 2017-2019 cycle were:

 The inability to maintain and retain primary health care providers

 Attracting and retaining young families which leads to infidelities and unfaithfulness in
marriages hence transmissions of STDs and STIs.
 Having enough daycare services
 The burden of Mental health illnesses.
 Drug n Substance abuse
 The burden of non-communicable diseases such as diabetes and high blood pressure.

Components of a Needs Assessment

The main outcomes of a community needs assessment are in 3 main categories:

i. Policy Change
ii. Systems Change
iii. Environmental Change.

Here nettt
Policy Change

This involves laws, regulations, rules, protocols, and procedures that are designed to guide or
influence behavior. Policies can be either legislative or organizational. Policies often
mandate environmental changes and increase the likelihood that they will become
institutionalized or sustainable. Examples of legislative policies include taxes on tobacco
products, provision of county or city public land for green spaces or farmers’ markets,
regulations governing a national school lunch program, and clean indoor air laws. Examples
of organizational policies include schools requiring healthy food options for all students,
menu labeling in restaurants, and required quality assurance protocols or practices (e.g.,
clinical care processes).

System Change.
This involves change that affects all community components including social norms of an
organization, institution or system. It may include a policy or environmental change strategy.
Policies are often the driving force behind systems change. Examples are implementing a
national school lunch program across a region or provincial school system or ensuring a
hospital system becomes tobacco free.

Environmental Change
This type of change relates to the physical, social, or economic factors designed to influence
people’s practices and behaviors. Examples of alterations or changes to the environment
include:
 a) Physical: Structural changes, the presence of programs and services which include
the presence of healthy food choices in restaurants or cafeterias, improvements in the
built environment to promote walking and support people living with disabilities (e.g.
construction of walking paths), the availability of smoking cessation services to
patients or workers, and the presence of comprehensive school health education
curricula in schools.
b) Social: A positive change in attitudes or behavior about policies that promote health
or an increase in supportive attitudes regarding a health practice, including an
increase in favorable attitudes of community decision makers about the importance of
nonsmoking policies or an increase in non acceptance of exposure to second-hand
smoke from the general public.
c) Economic: The presence of financial incentives to encourage a desired behavior like
charging higher prices for tobacco products to decrease their use.

Steps in assessing community needs.

The following are the most common needs

Step 1: Plan for a community needs assessment

 Identify and assemble a diverse community team

 Develop a team strategy.
 Define community to assess (e.g. region, village)
 Identify community sectors to assess (e.g. health care, schools)
 Identify community components to assess (e.g. nutrition, tobacco)
 Develop questions to ask for each community component
 Select sites and number of sites to visit within each sector
 Determine existing data to use or methods for collecting new data
 Identify key informants to contact.

Step 2: Conduct the needs assessment. this can be done through conducting interviews, holding
focus groups and data collection. This will give one the intensity of the need to assess.

Step 3: Review and rate the data

 Develop a rating scale for the data you have collected.
 Make a team decision on ratings this will make one come up with informed decisions and
up to date solutions.

Step 4: Record and review the consolidated data

 Enter the data into a system for referral purposes.
 Total the data to make it complete.
 Summarize and analyze the data.
Step 5: Develop a community health action plan.
 This is to identify community assets, liabilities, strengths and actual needs.
 Prioritize needs.
 Develop and prioritize strategies for improvement.
 Create an action plan for top priority strategies.
 Section 2: Plan for a Community Needs Assessment

INTRODUCTION
Planning for a community needs assessment is just as critical as conducting the actual
assessment. You need to ensure you have the right people to help out and that you have
identified the logistics and content of the assessment, what data to collect, how to collect the
data and from whom. In this section you will learn how to plan for a community needs
assessment, in particular how to:

•Identify and assemble a diverse community team

•Develop a team strategy
•Identify scope of assessment
•Develop questions to ask
•Select sites
•Determine data collection methods
•Identify key informants

IDENTIFY AND ASSEMBLE A DIVERSE COMMUNITY TEAM

Representation from diverse sectors of the community is critical to successful team work and
enables easy and accurate data collection and assessment. All members of the community
team should have an active role in the assessment process from developing questions to
identifying data collection methods to use. This process also ensures the community team has
equitable access to and informed knowledge of the process, thereby solidifying their support.
Identifying 10-12 individuals is recommended to ensure the size is manageable, allow for
adequate representation of different perspectives, and to account for attrition of members.
Include representatives of different stakeholder groups. Examples of types of stakeholders to
include on the community team are:
•Law enforcers
•Faith leaders
•Hospital administrators
•Community health workers
•School principal or headmaster (of primary school or university)
•Neighborhood council representatives
•Civic leaders
•Local advocates
•Local business leaders
•Local health practitioners.
When this community team has assembled one should clearly define the purpose of your
community team, capacity of team members and their organizations, identify potential barriers to
success, and plan for overcoming any obstacles. Ensuring adequate funding to support the
community team’s efforts is critical to the success of the project.

DEVELOP A TEAM STRATEGY

After you have assembled your team you will meet to develop a team strategy. This involves, at
a minimum:

i. Defining goals for the needs assessment

ii. Defining how the data collected will be used (e.g., to influence policy
makers, to support new programs, to support new changes in service
delivery or policies)
iii. Determining the timeline for the assessment (e.g. 3 months, 6months)
iv. Determining roles and responsibilities of team members
v. Assigning tasks based on skills and available resources
vi. Identifying how decisions will be made
vii. Selecting a method or tool for conducting the needs assessment (e.g.,
CHANGE tool, customized Excel spreadsheets, MS Word worksheets.

DENTIFY THE SCOPE OF THE ASSESSMENT

In this step you will determine the scope of your community assessment. During this process,
your team should define “community” and then keep this definition the same throughout the
needs assessment.
A community needs assessment should focus on:
 A selected community, such as a region or neighborhood
 Sectors within that area, such as health care and work sites
 Community components to assess within each sector, such as nutrition, chronic diseases
management, family planning and tobacco use, environmental pollution, school health
programes.
 Clearly define the Community to Assess. The community team will decide what
community to assess. Previously established areas (e.g., school districts, city limits). it
should consider starting with a smaller geographic area or segment of the population. It
might be easier to attain greater impact with a smaller sized community than a larger one
within the first year.
 Identify Community Sectors to Assess. Within the community identified, your team will
determine which distinct parts or sectors of the community to assess. Examples of
community sectors are.

Community-At-Large Sector:
It includes community-wide efforts that impact the social and built environments such as food
access, tobacco-free policies, walkability or bikeability, and personal safety.
Community Institution/Organization (CIO) Sector: includes entities within the community that
provide a broad range of human services and access to facilities such as childcare settings, faith-
based organizations, senior centers, health and wellness organizations, colleges and universities.

Health Care Sector : It includes places people go to receive preventive care or treatment, or
emergency health care services such as hospitals, private doctors’ offices, community clinics, or
health posts.
Work Site Sector: includes places of employment such as agriculture, manufacturing, private
offices, restaurants, retail establishments, and government offices.

School Sector: includes all primary and secondary learning institutions.

Community Components to Assess Within each sector, you should identify which components of
the community to assess. Choose ones that the community team believes are most important and
relevant to evaluate and that will lead to the most useful recommendations for improvement. For
example, you may want to assess demographics, statistical data of a population such as age,
income, education level, type of work site/health facility/school. For each sector, you will
determine which demographic factors that you want to assess. For example, in some sectors, you
might collect information on whether the population using the institution is from an urban or
rural setting. You will also assess whether each sector has the policies and systems in place to
evaluate risk and to help those in that system to engage in health promoting behavior.

Part of this assessment may include who provides leadership and how and assessing who are the
successful change agents. Policies, Systems and Environments
 Physical activity: the policy, systems or environmental change strategies in place that
support physical activity. For example, does the sector assess patients’ physical activity
as part of a written checklist or screening used in all routine office visits? Does it provide
access to public recreation facilities? Does it promote stairwell use
 Nutrition: the policy, systems or environmental change strategies in place that support
nutrition. For example, does the sector ensure that healthy food preparation practices
(e.g., steaming, low fat, low salt, limited frying) are always used? Does it implement a
referral system to help patients access community-based resources or services for
nutrition?
 Tobacco Use: the tobacco control-related change strategies in place. For example, does
the sector institute a tobacco-free policy24/7 for indoor/outdoor public places? Does it
ban tobacco vending machine sales? Does it provide access to a referral system for
tobacco cessation resources and services?
 Chronic disease management: the policy, systems or environmental change strategies in
place that support manage chronic diseases and its related risk factors. For example, does
the sector provide chronic disease self-management education to individuals identified
with chronic conditions or diseases? Does it implement a referral system to help patients
access community-based resources or services for chronic disease? Does it promote
chronic disease prevention?
 After school: the policy, systems or environmental change strategies in place that support
after school activities. For example, does the school ensure appropriate active time during
after-school programs or events? Does it institute healthy food and beverage options
during after school programs?
 Leadership: the policy, systems or environmental change strategies in place that relate to
the management of the community. For example, does the sector participate in
community coalitions and partnerships? Does it reimburse employees for preventive
health or wellness activities? Does it finance public parks/sports facilities?
 Legislative: the policy, systems or environment change strategies that are in place at the
school district level. For example, does the district ban tobacco advertising on school
 property, at school events, and in written educational materials and publications? Does
the school eliminate the sale and distribution of less than healthy foods and beverages
during the school day? Additional governmental levels.

Lesson six
Develop Questions To Ask The Community.
You will develop a list of questions to ask to learn about the strengths and weaknesses of
specific community components within each sector. Ensure you determine how the responses
will be measured (qualitative/quantitative) and include response options for quantitative
questions. For example, within the Health Care Sector, Physical Activity component, some
questions you may want to include in the assessment are:

To what extent does the health care facility :

•Promote stairwell use (e.g., make stairs appealing, post motivational signs near stairs to
encourage physical activity) to patients, visitors, and staff?
•Assess patients’ physical activity as part of a written checklist or screening used in all
routine office visits?
•Provide regular counseling about the health value of physical activity during all routine
office visits?
•Implement a referral system to help patients’ access community-based resources or services
for physical activity? Examples of questions to include if assessing the tobacco component of
the health care sector are:

To what extent does the health care facility:

•Institute a smoke-free policy 24/7 for indoor public places?
•Institute a tobacco-free policy 24/7 for indoor public places?
•Institute a smoke-free policy 24/7 for outdoor public places?
•Institute a tobacco-free policy 24/7 for outdoor public places?
•Assess patients’ tobacco use as part of written checklist or screening used in all routine
office visits?
•Assess patients’ exposure to tobacco smoke as part of written checklist or screening used in
all routine office visits?
•Provide advice and counseling about the harm of tobacco use and exposure during all office
visits?
•Implement a referral system to help patients to access tobacco cessation resources and services.

Lesson 7
SELECT SITES
Sites are the locations within each sector that will be visited to conduct the needs assessment. At
each site, the information gathered will provide answers to the questions you have identified. Be
sure to systematically choose a variety of sites within each sector to show the extent of work
being done in the community. Some schools, for example, may be ready to pass a physical
activity policy while others have not yet begun to consider the need. A diversity of policy
implementation enhances your data-gathering process. If you only choose sites that are excelling,
it will be more challenging to identify gaps and needs when you develop your Community
Action Plan. It is important to document the process for site selection. It is recommended that
besides the community-at-large sector, you assess a minimum of 3 sites per sector.

DETERMINE DATA COLLECTION METHODS OR USE EXISTING DATA

Use a variety of data-gathering methods to access and collect information for each site. Data
come in many forms; varying data-collection methods provides a more comprehensive
assessment of your community.

Data collection methods

1. direct observation: enables a person to better understand the environment in which

people interact and to see the things of which others may not be aware. It may also
produce useful information that may not be apparent from your other data-collection
methods.

2. key informant interview or focus group. This type of data-collection allows you, the
observer, to choose a location or event and watch what is happening. A combination of 2
or more data-collection methods is recommended at each site to confirm or support initial
findings.
3. use of photography: photography enables one to collect different types of data and also
to have a portfolio of evidence. e.g photos of a walkable streets or congested
intersections unfriendly to pedestrians may supplement the feedback from an independent
survey. The goal of this step is to reflect the voices of the community through a diverse
set of data-collection methods and to mobilize support by demonstrating a detailed,
thorough method of data-collection.
4. use of questionnaires. There are two types of questionnaires.
A) open ended- these are questions that have an open chance of responses foe example :
how has school been?
b) Close ended questions: these are questions that participants don’t have a chance to
explain or to expound on the matter of concern. E.g are you feeling unwell ? ( yes/ no)
5. use of surveys: surveys collect information from a targeted group of people about their
opinions, behavior, or knowledge.
6. interviews: Interviews are used to collect data from a small group of subjects on a
broad range of topics. You can use structured or unstructured interviews.
Structured interviews are comparable to a questionnaire, with the same questions in the
same order for each subject and with multiple choice answers.

Comprehensive data enable a more effective action plan for community improvements, so
perform this task carefully to ensure the data needed to make decisions are available. Also
consider if your community has already gathered data for another purpose. To determine if you
can use that information for the needs assessment, consider the following:
 •How old are the data? If data are less than 6 months old they can be used. If not, it is time to
gather new data.

•Do you have all the information needed?

•Is the information gathered relevant?

•Can you use the data in the existing format or there needs some changes?

•Do you need more data?

•Does anyone on your team have experience with analyzing data?

If a data source is older than 6 months that is acceptable to use. However, note the frequency
with which the data are collected.

15/3/21
Lesson 8

IDENTIFY KEY INFORMANTS TO CONTACT

For each sector and site your team has identified for the assessment, contact people (or key
informants) in the community who can provide the appropriate insight, knowledge, or
documentation. Community team members can then reach out and contact people from the
community (e.g., school principal, business leaders, city planners, police, chief, hospital
administrator) who should have access to the desired information or can point them in the right
direction.

DOCUMENTATION
Keep a comprehensive file of all sources of information, key contacts, the data to review at a
later date or to share with coalition members. The file can be in multiple forms notebooks or
bound volumes, facilitator guides, field notes, meeting minutes, or an electronic data file. The
purpose of cataloguing all the data files is to ensure that everything your team collects can be
accessed and used.

First assignment
Questions:
1. 1 .If you were planning a community needs assessment, what are some components of a
team strategy that you would develop?

2. Describe the community you will assess including at least 4 community sectors.

3. For each community sector, list at least 5 community components to assess.

4. Select one community component and list at least 3 types of questions to ask to learn
about strengths and weaknesses.
 5. For one of the community sectors you will assess, list at least 2 sites to visit.

6. For 1 of the sites you will visit, list at least one data collection method you will use.

7. For 1 of the sites you will visit, describe the key informants who your team will contact.

Planning for a community needs assessment includes :

 Identify and assemble a diverse community team
 Develop a team strategy
 Define the community to assess ( school districts, city limits)
 Identify community sectors to assess ( health care, schools)
 Identify community components to assess (nutrition, tobacco use)
 Develop questions to ask for each component, including how the responses will
be measured
 Select sites and number of sites to visit within each sector
 Determine existing data to use or methods for collecting new data
 Identify key informants to contact.

Identifying 10-12 individuals maximum for your community team is recommended to ensure the
size is manageable and to account for attrition of members. A community needs assessment
should focus on a particular geographic area, sectors within that area such as health care and
work sites, and community components to assess within each sector such as nutrition, chronic
disease management, and tobacco use.

A combination of 2 or more data-collection methods is recommended at each site to confirm or

support initial findings.

Keep a comprehensive file of all sources of information, key contacts, and data to review at a
later date or to share with coalition members.

Review and Rate the Data

Before recording the data collected from the needs assessment into a data capturing tool, such as
the Change tool, your team should review the information from each site to gain consensus on
how to rate each item. Rating the data helps to identify strengths and weaknesses. The team
should discuss the data, share what each person found, and identify evidence to support the
team’s rating.

In this section, you will learn:

•The difference between policy and environmental change strategies,

•How to develop a rating scale

•How to reach consensus on rating data.

Lesson 9

Record and Summarize Data

Designate one person as the data manager within the team. This person should be responsible for
entering the data for each of the sites into the data tools being used. If your team is using the
CHANGE tool, the data manager should have a basic working knowledge of MS Excel, such as
opening and closing files, entering macros, and entering data in fields.

Create a Community Action Plan

At this stage of the community needs assessment, you should have summarized the data the team
has collected and are ready to identify the community assets and needs. In this final section of
the workbook you will learn how to use your summary information to identify areas for
improvement and then transform them into measurable action items. The outcome of this step is
a Community Action Plan which will contain Specific, Measurable, Attainable, Realistic and
Timely (SMART) objectives and the activities to support those objectives. You should present
needs assessment findings and obtain approval from stakeholders and community leaders on the
strategies before developing an action plan.

ASSETS NEEDS

Health Care Sector:

•Two facilities promoted stairwell use to patients, visitors, and staff
•Patients referred to smoking cessation programs at all sites School Sector: •1 of the schools was
initiating a plan to ensure the playground equipment meets safety standards

Work Site Sector

•Employee wellness coalition developed by local small business

• All sites have designated, safe walking paths on building property
•4 out of 5 sites implemented a referral system for tobacco cessation services•75% of the health
care professionals do not provide patient education on nutrition or physical activity
School Sector:
•No requirements for physical activity during school day 2 of the 3 schools offered no healthy
food or beverage options

PRIORITIZE NEEDS
If you have identified many community needs, your team should prioritize those needs. Some
criteria you may consider when prioritizing needs are:
 Size of the problem
 Seriousness of problem
 Availability and accessibility of any interventions
 Economic and social-cultural impact on the community
 Public health needs and concerns
  Availability of resources for implementation

IMPLEMENTING THE ACTION PLAN AND SHARING PROGRESS

After completing the community needs assessment and developing a communication action plan,
coordinate your resources to make sure the activities you have identified are completed on time.
Track your progress, note key successes, and document any obstacles to implementing the action
participated in the assessment. Community teams should not list who they talked with or provide
specific details about data that could specifically link to an individual or organization. Share data
in aggregate for a sector.

Lesson 10

Universal health coverage (UHC)

What is UHC?

Introduction

Universal Health Coverage (UHC), referring to access to healthcare without financial burden,
has received renewed attention in global health spheres. UHC is a potential goal in the post-2015
development agenda. Monitoring of progress towards achieving UHC is thus critical at both
country and global level.

UHC means that all individuals and communities receive the health services they need without
suffering financial hardship. It includes the full spectrum of essential, quality health services,
from health promotion to prevention, treatment, rehabilitation, and palliative care.

UHC enables everyone to access the services that address the most significant causes of disease
and death, and ensures that the quality of those services is good enough to improve the health of
the people who receive them.

Protecting people from the financial consequences of paying for health services out of their own
pockets reduces the risk that people will be pushed into poverty because unexpected illness
requires them to use up their life savings, sell assets, or borrow – destroying their futures and
often those of their children.

Achieving UHC is one of the targets the nations of the world set when adopting the Sustainable
Development Goals in 2015. Countries that progress towards UHC will make progress towards
the other health-related targets, and towards the other goals. Good health allows children to learn
and adults to earn, helps people escape from poverty, and provides the basis for long-term
economic development.
What UHC is not

There are many things that are not included in the scope of UHC:

 UHC does not mean free coverage for all possible health interventions, regardless of the
cost, as no country can provide all services free of charge on a sustainable basis.
 UHC is not just about health financing. It encompasses all components of the health
system: health service delivery systems, the health workforce, health facilities and
communications networks, health technologies, information systems, quality assurance
mechanisms, governance and legislation.
 UHC is not only about ensuring a minimum package of health services, but also about
ensuring a progressive expansion of coverage of health services and financial protection
as more resources become available.
 UHC is not only about individual treatment services, includes population-based services
such as public health campaigns, adding fluoride to water, controlling mosquito breeding
grounds.
 UHC is comprised of much more than just health; taking steps towards UHC means steps
towards equity, development priorities, social inclusion and cohesion.

16 essential health services universal health coverage is focusing on:

Reproductive, maternal, newborn and child health.

 family planning for groups under the gap of reproductive health.

 antenatal and delivery care
 full child immunization and vaccination against vaccine preventable diseases.
 health- seeking behaviour for pneumonia and malaria.

Infectious diseases.

 tuberculosis treatment
 HIV antiretroviral treatment
 Hepatitis vaccination and treatment
 use of insecticide-treated bed nets for malaria prevention.
 adequate sanitation.

Non communicable diseases:

 prevention and treatment of raised blood pressure

 prevention and treatment of raised blood glucose
 cervical cancer screening
 tobacco (non)smoking.

Service capacity and access:

 basic hospital access

  health worker density
 access to essential medicines
 health security: compliance with the International Health Regulations.

Each country is unique, and each country may focus on different areas, or develop their own
ways of measuring progress towards UHC. But there is also value in a global approach that uses
standardized measures that are internationally recognized so that they are comparable across
borders and over time.

Health insurance

Introduction

Health insurance is an insurance that covers the whole or a part of the risk of a person incurring
medical expenses, spreading the risk over numerous persons. By estimating the overall risk of
health risk and health system expenses over the risk pool, an insurer can develop a routine
finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the
health care benefits specified in the insurance agreement. The benefit is administered by a central
organization such as a government agency, private business, or not-for-profit entity.

A health insurance policy is:

A contract between an insurance provider (e.g. an insurance company or a government) and an

individual or his/her sponsor (that is an employer or a community organization). The contract
can be renewable (annually, monthly) or lifelong in the case of private insurance, or be
mandatory for all citizens in the case of national plans. The type and amount of health care costs
that will be covered by the health insurance provider are specified in writing, in a member
contract or "Evidence of Coverage" booklet for private insurance, or in a national [health policy]
for public insurance

The individual insured person's obligations may take several forms:

 Premium: The amount the policy-holder or their sponsor (e.g. an employer) pays to the
health plan to purchase health coverage. According to the healthcare law, a premium is
calculated using 5 specific factors regarding the insured person. These factors are age,
location, tobacco use, individual vs. family enrollment, and which plan category the
insured chooses. Under the Affordable Care Act, the government pays a tax credit to
cover part of the premium for persons who purchase private insurance through the
Insurance Marketplace.
 Deductible: The amount that the insured must pay out-of-pocket before the health insurer
pays its share. For example, policy-holders might have to pay a 7500 deductible per year,
before any of their health care is covered by the health insurer. It may take several
doctor's visits or prescription refills before the insured person reaches the deductible and
 the insurance company starts to pay for care. Furthermore, most policies do not apply co-
pays for doctor's visits or prescriptions against your deductible.
 Co-payment: The amount that the insured person must pay out of pocket before the health
insurer pays for a particular visit or service. For example, an insured person might pay a
45 co-payment for a doctor's visit, or to obtain a prescription. A co-payment must be paid
each time a particular service is obtained.
 Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment),
the co-insurance is a percentage of the total cost that insured person may also pay. For
example, the member might have to pay 20% of the cost of a surgery over and above a
co-payment, while the insurance company pays the other 80%. If there is an upper limit
on coinsurance, the policy-holder could end up owing very little, or a great deal,
depending on the actual costs of the services they obtain.
 Exclusions: Not all services are covered. Billed items like use-and-throw, taxes, etc. are
excluded from admissible claim. The insured are generally expected to pay the full cost
of non-covered services out of their own pockets.
 Coverage limits: Some health insurance policies only pay for health care up to a certain
dollar amount. The insured person may be expected to pay any charges in excess of the
health plan's maximum payment for a specific service. In addition, some insurance
company schemes have annual or lifetime coverage maxima. In these cases, the health
plan will stop payment when they reach the benefit maximum, and the policy-holder must
pay all remaining costs.
 Out-of-pocket maximum: Similar to coverage limits, except that in this case, the insured
person's payment obligation ends when they reach the out-of-pocket maximum, and
health insurance pays all further covered costs. Out-of-pocket maximum can be limited to
a specific benefit category (such as prescription drugs) or can apply to all coverage
provided during a specific benefit year.
 Capitation: An amount paid by an insurer to a health care provider, for which the
provider agrees to treat all members of the insurer.
 In-Network Provider: A health care provider on a list of providers preselected by the
insurer. The insurer will offer discounted coinsurance or co-payments, or additional
benefits, to a plan member to see an in-network provider. Generally, providers in network
are providers who have a contract with the insurer to accept rates further discounted from
the "usual and customary" charges the insurer pays to out-of-network providers.
 Out-of-Network Provider: A health care provider that has not contracted with the plan. If
using an out-of-network provider, the patient may have to pay full cost of the benefits and
services received from that provider. Even for emergency services, out-of-network
providers may bill patients for some additional costs associated.
 Prior Authorization: A certification or authorization that an insurer provides prior to
medical service occurring. Obtaining an authorization means that the insurer is obligated
to pay for the service, assuming it matches what was authorized. Many smaller, routine
services do not require authorization.
 Formulary: the list of drugs that an insurance plan agrees to cover.
 Explanation of Benefits: A document that may be sent by an insurer to a patient
explaining what was covered for a medical service, and how payment amount and patient
responsibility amount were determined. In the case of emergency room billing, patients
are notified within 30 days post service. Patients are rarely notified of the cost of
 emergency room services in-person due to patient conditions and other logistics until
receipt of this letter.

questions.

1. Explain why health insurance is important.20 marks.

2. Explain why data collection is essential in assessing community needs.(20 marks)
3. Language barrier is stumbling block when delivering health services discuss.(20
marks)

Community mobilization

Community mobilisation is about organizing the community and all the resources available in
the community to move them towards achieving a certain health program goal. It is a capacity
building process, through which individuals, groups and families.

Community-based participatory approaches to community mobilisation will help to achieve

reliable and sustainable healthy lifestyles and behavioural changes. Through community
involvement, lay and professional people study health problems, pool their knowledge and
experience, and develop ways and means of solving their health problems. Your role is to help
the community organise itself so that learning will take place and action follows. The health
activity cannot achieve the intended goals without involving the community. This can only be
achieved by building on the community’s knowledge and beliefs through a continuous dialogue,
and not by dictating to them what they should do.

Key steps in community mobilization

1. Create awareness of the health issue
2. Motivate the community through community preparation, organisational development,
capacity developments and bringing allies together
3. Share information and communication
4. Support them and provide incentives.
5. generate resources.

ACHIEVING COMMUNITY MOBILISATION

Community and Social mobilization is the backbone for strengthening global partnership and
ensuring that it remains accountable to people’s overlapping needs and demands, whether in
health, gender equality, labour or otherwise.
Stakeholders involved in achieving community mobilization include:
1. Government
Expand space for civil society engagement in decision-making, taking necessary precautions to
protect against the efforts of industry-backed front groups to interfere with healthy public policy
making.
2. Civil society
Explore opportunities and innovative means to build cross-constituency partnerships for
overlapping injustices and common causes, with an emphasis on south-south and triangular
cooperation amongst CSOs.

3. Media (including social media)

Work with civil society to ensure that governments are committed to do as they have stated.
Media platforms both new and old can be used to engage a wide population on decision-making
processes related to health and sustainable development.

4. Organizations of the UN system

Support the development of win-win policies and programs to scale up advocacy and community
mobilization for health and the SDGs, engaging as appropriate with media and civil society.
5. Community leaders
Mobilize affected communities and constituencies to respond to health and development
injustices, supporting their capacity to push back and organize, and build cross-cutting capacities
within change agents.
6. Research and academic institutions
Develop and improve methods to evaluate social mobilization using an evidence-based approach
as both a process and an outcome. Valid and reliable tools are especially needed to measure the
(often complex) social and organizational aspects of social mobilization as these pertain to a
range of SDGs.
Tools and techniques of collecting information.
You can collect essential information on community mobilization using the following tools and
techniques.

i. Direct observation
ii. Group interviews
iii. Sketching maps
iv. Role-plays
v. Stories
vi. Proverbs
vii. Workshops

WORKING WITH THE COMMUNITY

i. Go to the community
ii. Love with them
iii. Live with them
iv. Learn from them
v. Link your knowledge with them
vi. Start with what they have
 vii. When you finish your job, the people will say we did it all by ourselves.

Community mapping
During community mapping a map is drawn of selected physical features on a flat surface
The selected features for a village:
The natural resources.
The poverty pattern(s).
The territory of the village.
The housing pattern(s).
The cropping pattern(s).
The space and the area the village occupies.

TB and HIV/AIDS Defaulter tracing

Who are the defaulters?

The formal definition of a defaulter varies by country. The epidemiological categorisation of a

defaulter designates an individual who fails to complete a course of treatment, and often carries a
negative connotation of blame towards the patient.
CHWs work in collaboration with other health care workers (nurses, ART clerks, clinical
officers) in order to identify ‘defaulters’ from the registers and patient cards, which contain basic
information about patients (such as the name, and sometimes the address or village, phone
number, ART card number, patient register number).

FACTORS CONTRIBUTING TO DEFAULTING

1. Some women don’t come back to pick their after being introduced to ARTs
treatment because they fear that their husbands will ask them why they swallow
drugs every day. Some of these women don’t go to the clinic with their husbands
so when they are tested positive they fear to tell them, and when they are started
on treatment they again fear to tell them that they are on drugs because their
husbands will think they are the ones who went outside and got HIV. Men are not
actively involved in this programme of going to the hospital with their wives
during the first antenatal visit. If men were to get tested for HIV and involved,
they could be more understanding. Experience has shown that when women
receive treatment, they do not take it in the presence of the husband. They take it
secretly because by then the husband has not yet accepted her status. Women do
not disclose their status at times to their husbands and that is part of the problem.

2. The behaviour of some of the healthcare workers contributes to patients leaving

treatment; some clients will openly say they stopped taking treatment because
some health workers insulted her in front of other patients which lowered their
self esteem.

3. Giving birth to HIV negative children was also cited by one CHW as another
cause for loss to follow up after giving birth to HIV free children they mothers
 don’t come back for treatment. Their only aim was to have a child without HIV,
that is all.

4. Another reason for stopping treatment was linked to religious beliefs and
practices. when these women put their faith in prayers, they at the same time find
it to contradicting to be taking the antiretrovirals for HIV treatment some church
representatives and religious leaders advised patients against taking HIV
treatment: There are some churches which according to their doctrines don’t
allow their members to go to the hospital when they are sick, instead they just
want to pray for them. They say ‘I can’t access ART treatment, I rely on prayers, I
depend on Jesus.

5. Stigma remains an important concern for patients. They fear that accessing
treatment for HIV may jeopardize their reputation and relationships with others
living in the same neighbourhood. People are ashamed of being seen by their
neighbours at the clinic if you are seen in the queue, then you are HIV-positive.

Active default tracing is an integral part of tuberculosis (TB) programmatic control. It can be
differentiated into the tracing of defaulters patients not seen at the clinic for less or =2 months
and late patients late for their scheduled appointments.

Tracing is carried out to obtain reliable information about who has truly died, transferred out or
stopped treatment, and, if possible, to persuade those who have stopped treatment to resume.
This is important because TB has the potential for transmission to other members of the
community, and therefore presents the issue of the rights of the individual over the rights of the
community.

NON-COMMUNICABLE DISEASES FOLLOW UPS.

Non communicable diseases (NCDs), also known as chronic diseases, tend to be of long duration
and are the result of a combination of genetic, physiological, environmental and behaviours
factors.

The main types of NCDs are:

i. cardiovascular diseases (like heart attacks and stroke).
ii. Cancers.
iii. chronic respiratory diseases such as chronic obstructive pulmonary disease and
asthma.
iv. diabetes.

People at risk of non-communicable diseases:

People of all age groups, regions and countries are affected by NCDs.
These diseases are driven by forces that include rapid unplanned urbanization, globalization of
unhealthy lifestyles and population ageing. Unhealthy diets and a lack of physical activity may
show up in people as raised blood pressure, increased blood glucose, elevated blood lipids and
obesity. These are called metabolic risk factors that can lead to cardiovascular disease, the
leading NCD in terms of premature deaths.

Risk factors
1. Modifiable behavioural risk factors
2. Modifiable behaviours, such as tobacco use, physical inactivity, unhealthy diet and the
harmful use of alcohol, all increase the risk of NCDs.
3. Metabolic risk factors contribute to four key metabolic changes that increase the risk of
NCDs like :
i. raised blood pressure
ii. ii overweight/obesity
iii. hyperglycemia (high blood glucose levels) and
iv. hyperlipidemia (high levels of fat in the blood).

In terms of attributable deaths, the leading metabolic risk factor globally is elevated blood
pressure (to which 19% of global deaths are attributed), (1) followed by overweight and obesity
and raised blood glucose.

Prevention and control of NCDs

Non-communicable diseases(NCDs are diseases that can not be transmitted from one person to
another. Most of these NCDs are usually lifestyle related and genetically inherited.

An important way to control NCDs is to focus on reducing the risk factors associated with these
1diseases. Low-cost solutions exist for governments and other stakeholders to reduce the
common modifiable risk factors. Monitoring progress and trends of NCDs and their risk is
important for guiding policy and priorities.

To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed
requiring all sectors, including health, finance, transport, education, agriculture, planning and
others, to collaborate to reduce the risks associated with NCDs, and promote interventions to
prevent and control them.