Community Research and Development Information Service - CORDIS


REACHOUT Report Summary

Project ID: 306090
Funded under: FP7-HEALTH
Country: United Kingdom

Periodic Report Summary 3 - REACHOUT (Reaching out and linking in: Heath systems and close-to-community services)

Project Context and Objectives:
Countries striving to provide universal health care coverage and meet the Sustainable Development Goal targets are increasingly implementing close-to-community (CTC) health services. There is a need for health systems to better understand the context and conditions in which these services operate in order to realise their potential. Furthermore in the push to expand service access it is important that issues of quality remain at the forefront of community health system development.
Working with some of the most respected close-to-community services in Africa and Asia (in Bangladesh, Ethiopia, Indonesia, Kenya, Malawi, Mozambique), REACHOUT has identified barriers to quality CTC service delivery and implemented quality improvement initiatives related to supervision, as well as documenting lessons for health system development and strengthening. The CTC services we work with include those provided by community health workers, midwives, traditional birth attendants, informal private practitioners, and lay counsellors.
Our main objectives remain: to build capacity to conduct and use health systems research to improve CTC services; to identify how community context, health policy and interactions with the rest of the health system influence the equity, effectiveness and efficiency of CTC services; to develop and assess interventions with the potential to make improvements to CTC services and to inform evidence-based and context-appropriate policy making for CTC services.

Project Results:
REACHOUT has completed three and a half years of work to date, progressing to a deep level of contextual knowledge in each country setting as well as identifying significant generalizable findings.
To address one of the common barriers to performance of CTC providers identified through literature review and country context analyses, a supportive supervision intervention to improve quality was developed in the second year of the project. The training curriculum developed was implemented with supervisors of CTC providers in all six countries and common indicators around frequency of supervision, approach to supervision and motivation of CTC providers were collected over time, along with qualitative data. This common approach and the collection of common indicators will assist us in our inter-country analysis.
Building on the successes of what we call a ‘researcher-led’ approach to quality improvement, we are now focused on shifting to a ‘district-led’ approach which is owned by local health staff. This necessitated development of training material on quality improvement and cascading this training to district teams in each country. The district quality improvement teams are currently conducting their own problem identification and collecting data. In the last months of REACHOUT, these district teams will identify an intervention and collect data on the improvement, while our researchers observe the process and write up the case studies and inter-country findings on embedding quality improvement.

Based on our capacity needs assessment, we are conducting capacity building for three different groups: researchers, CTC providers and policy makers. Each consortium member institution has a capacity building champion to initiate, monitor and report progress. Frequent consortium-wide workshops are held to build the capacity of the REACHOUT researchers. Policymakers from all countries have attended at least one of these workshops, exposing them to the evidence generated by REACHOUT as well as the policies and practices around community health in other countries. CTC providers and their supervisors have been trained in supportive supervision practices and quality improvement tools and concepts in each country.
Finally, we have conducted significant commuications and research uptake activities via scholarly and other outputs and activites. This work has been driven by an analysis of our target audiences that used various situational analysis and stakeholder mapping tools. Our plans encompass the sub-natioal, national and international levels. Progress is monitored using a variety of systems, tools and indicators. The consortium has website which is regularly updated and communicates using a variety of online social media sites such as Twitter, YouTube, and Flickr. We have participated in national and international conferences and we play a key role in running the Thematic Working Group on Supporting and Strengthening the role of Community Health Workers through Health Systems Global. We hope this will continue to provide an inclusive and dynamic platform for the exchange of knowledge on close to community providers. 9 peer-reviewed papers were published during this period, and posters and oral sessions have been accepted to presentation in multiple international conferences.
To date, REACHOUT has successfully completed all due deliverables, and met all milestones.

Potential Impact:
With a focus on equity, efficiency and effectiveness of community health services, we are generating evidence around what works in each of those areas using a combination of outcomes and process indicators in a mixed methods approach. Some evidence is country-specific, driven by specific policies and actors in country. However, some of the strongest evidence we are generating is inter-country work on things like: costing community health, interface role of community health workers between communities and health systems, gender, and governance. These will be show-cased as papers as well as in the 2018 Health Systems Global meeting (to be hosted by the Liverpool School of Tropical Medicine), where we are designing a CHW space that will be informed strongly by this work.
We are also assessing the impact of the capacity building work we have done and the impact at individual, institutional and environmental levels. This will be related to concerns identified in the context analysis such as human resource scarcity, policy and transition. Some of the contribution of REACHOUT here will be in development of new tools and methods, while in other areas it will involve strategies and recommendations to obtain a better return on investment for the health system as it invests in capacity strengthening.
The quality improvement cycle interventions are being assessed using an adapted common analytical framework to find out what works, in which context and what can be improved. Analyses include community and policy maker perspectives and the extent of CTC providers’ voices in health planning. These allow assessment of the broader societal, socio-cultural and gender implications of the quality improvement cycles.
Through conducting a robust inter-country analysis we will build much needed transferable policy and practice recommendations to strengthen CTC services and empower providers, researchers and policy makers.

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