Table 3

Community-based models of care in paediatrics

Key messagesWhy is it important?Current challengesRecommendations
Community models of care are effective in delivering a range of preventive, promotive and curative health services for children and neonates, and they can contribute to reducing inequities in access to care.In humanitarian and fragile settings when access to health facilities is limited, care at community level can bridge important health gaps for mothers, newborns and children.


The community-based activities are an essential part of the health system, contributing to build skills and confidence to empower people with knowledge, tools and understanding referral needs.
  • Community activities suffer from lack of anchorage with the existing health system and tend to be implemented as a parallel system.

  • Monitoring and evaluation (M&E) of the service delivered is hampered by the lack of clear and simple core indicators.

  • Community health workers (CHW) are given more and more responsibilities, their skills and workload not always match.

Field
  • Community models of care should be rooted in understanding of the context, social realities and values of the communities we are working with and designed in a participatory manner.

  • Simplified core indicators of implementation, quality of care and utilisation of services should be implemented to allow M&E, along with qualitative data to understand important barriers and enablers.

  • Involve communities in M&E of programmes at a minimum through assuring context-appropriate feedback mechanisms are in place.

  • Ensure realistic workload of the CHW and enhance their motivation through social recognition of their work, an appropriate reward system, regular supervision, feedback, exchanges, sense of belonging to a larger network.


Operations
  • Community activities should be built on existing capacity, avoiding the implementation of a parallel system.


Headquarters
  • Provide a framework for assessing/training CHWs and a catalogue of relevant expectations of CHW dependant on achievable and most relevant competencies.

‚ÄÉCommunity models of care in emergency response are most effective if the model is implemented in advance with contextual emergency preparedness (EPREP) strategies.Empowering the community in delivering healthcare increases resilience during crises when access to the health facilities may be further limited.
  • Planning and preparation are essential to deliver effective emergency response, but there is still little investment in EPREP at community level.

Field/operations
  • Integrate paediatric and neonatal community activities in the EPREP strategy.


HQ
  • Further simplify tools, M&E indicators and a framework for prioritisation for community activities during emergency response.

  • CHW, Community health workers; EPREP, Emergency preparedness; HQ, Headquarters; M&E, Monitoring and Evaluation.