Senegal Case Study: Scaling Up Community Health Services to the National Level

through INGO Partnerships

Presentation:David Shanklin, MSIntegrating Community-Based Strategies into Existing Health Systems: The Unique Role of INGOsMay 5 – 9, 2014Silver Spring, MD

Original Purpose of the Program • Health huts in Senegal have been in existence since 1978,

inspired by the spirit of the Alma Ata Declaration and the promise of universal primary health care.

• Health juts were intended to provide basic health promotion and selected curative services in areas without immediately available public health facilities.

• Public support for health huts was abandoned by the mid-1980s, and almost all were closed by the end of the decade.

• A new health hut initiative was begun in 1998 as a pilot project by ChildFund (then known as Christian Children’s Fund) in order to resuscitate health huts at a local level.

Scaling Up Senegal’s Community Health Services

Project Characteristics USAID Projects

CANAH CANAH II CAMAT PSSC PSSC II

Dates 1998-02 2002-06 2003-06 2006-11 2011-16

USAID Funding Source CSHGP CSHGP Mission Mission Mission(Sector Focus) (MCH) (MCH) (TB/Malaria) (Integrated) (Integrated)

USAID Funding Levels $992,218 $1.25 Million $870,846 $26 Million $40 Million

Geographic Coverage 2 Districts 3 Districts 4 Districts 13 Regions 14 Regions65 Districts 71 Districts

Target MCH Population 137,000 163,393 502,035 3,369,633 9,098,014(>25% of Nat'l Pop) (>70% of Nat'l Pop)

Health Huts/ 60 HH 154 HH N/A 1,620 HH/ 2,245 HH/Outreach Sites 703 Sites 1,969 Sites

Scaling Up: Project’s Learning Transitions

CANAH:• Formative

research identifying and working with key community stakeholders

• Organizing & training health committees and HVs

• Organizing HH and later, Outreach Sites

CANAH II:• Extending community

health services • Liaising with local

MOH• Formulating unified

vision of health

PSSC:• Standardizing basic CB MCH• Coordinating CB MCH with multiple

implementing partners• Nationwide scale-up

PSSC II:• Urban extension• Additional service components• Transfer of HH/OS to community and MOH

CAMAT:• Additional services,

such as TB, Malaria and Nutrition

• Increased service area coverage

Health Promotion/Communication

Health Systems Strengthening

EP

I

Facility

S

erv

ices

Com

mu

nity

H

ealth

HIV

/AID

S/T

B

USAID/Senegal's Conceptual Pirogue: Improved Health Status of the Senegalese Population

Community-Based Strategy

Community mobilization using multiple local groups with consistent health messages and practices (based on early formative research) –

• Project’s community mobilizers

• Community health workers and volunteers (TTBA, health volunteers, community educators, health committee members)

• TB cells• Youth

Community-Based Strategy (cont’d)

• Pregnant women’s solidarity groups• Grandmothers and godmothers• Community leaders

Rural and urban populations dependent primarily on the health huts and outreach sites for health services.

Estimated total population – 9,098,014

Infants and children 0–5 years – 1,771,968

Children of school age – 2,544,364

Pregnant/lactating women – 354,394

Women of reproductive age – 2,090,013

Target Population

Intervention Areas

14 Regions

71 Districts out of 75

4,214 Health Huts/Outreach Sites

Strengths of INGO Participation• Geographic expansion and population coverage• Expansion in the number of services provided• Standardization of services and systems• Engagement of MOH at the local, regional and

national levels

Most Recent Results• October 2013 national Community Health Policy• April 2014 Five Year Strategic Plan for Community

Health

Thank You