Optimising close-to-community services Close-to-community (CTC) care is increasingly being implemented in developing countries striving to meet Millennium Development Goals. The approach helps overcome various obstacles to universal access to health care through promotional, preventive or curative health services. Industrial Technologies © Thinkstock To realise the potential of CTC, health systems need to be understood in terms of the context and conditions in which these services operate. The 'Reaching out and linking in: Health systems and close-to-community services' (REACHOUT) project is identifying the best means for delivering CTC services. The overall goal is to maximize equity, effectiveness and efficiency in rural and urban slum areas of Bangladesh, Ethiopia, Indonesia, Kenya, Malawi and Mozambique. Researchers reviewed the literature to establish an inventory of potential constraints or enablers of the performance of CTC providers. They developed an analytical framework to create common methods and tools for country-specific context analyses, in addition to qualitative research and data analysis workshops. These activities highlighted four common areas of concern: supervision of CTC providers, community engagement, referrals from CTC providers to health facilities, and coordination between stakeholders and CTC providers. This baseline information will be used to advance interventions for service improvements, and build capacity for three stakeholder groups: practitioners, researchers and policymakers. REACHOUT agreed on common methods and tools, and has drawn up a methods manual to support partners in subsequent project work. A research uptake strategy has also been designed, and partners are mapping the communications ecology and policy environment in participating countries as well as internationally. Advocacy and relationship-building work has commenced to maximise the engagement of policymakers in all project stages. REACHOUT will use a combination of outcome and process indicators as well as other methods to evaluate impact on equity, efficiency and effectiveness. The project maintains a strong online presence through its website and various social media sites such as Twitter, YouTube and Flickr. Partners have also participated in international conferences such as the Women Deliver conference and engaged in international networks such as the Global Health Workforce Alliance. Ongoing work will inform transferable policy and practice recommendations empowering the three stakeholder groups. Overall, REACHOUT is generating a better understanding of the factors impacting health services. Project outcomes are slated to deliver needed interventions that will ultimately improve on the use of health systems for better CTC services. Keywords Close-to-community services, health care, health systems, CTC providers, community engagement
