Name: Community Assessment and Planning Process
Origin:
Source: BASICS
Basic Description: The design of the community assessment and planning process reflects current interest in decentralized planning for local health care, and increased community involvement (and cost sharing) in health service delivery. It responds to a need for increased skills and tools for local level decision making and collaborative planning.
The assessment is conducted by a team of community volunteers and health staff who use a participatory learning for action (PLA) process, and an integrated household survey to guide planning and develop a joint action plan. The process combines quantitative household survey to learn about community practices regarding key maternal and child health behavior and a qualitative approach to rank problems and identify solutions.
Country Applications: Pilot testing has been conducted in Ethiopia and Zambia by BASICS.
Languages Available: English
Technical Scope: Maternal and child health practices.
Purpose: The assessment and planning process enables governmental health staff and community members to work together to identify and prioritize maternal and child health problems and develop a plan to solve them.
Type of Methods: Quantitative household survey and, in the PLA, qualitative semi-structured interviews, seasonal calenders and matrix ranking.
Design: Descriptive, cross sectional household survey followed by descriptive analysis conducted jointly by health staff and community.
Frequency of Administration: When planning in maternal and child health programs is required.
Key Users of Information:
Objectives and Scope of Tool
The goal of this tool/process is to promote joint planning among health staff and the communities they serve. The tool produces data on maternal and child health behaviors. Features of the tool/process include:
Key Monitoring Needs and Evaluation Questions the Tool Seeks to Address
The tool guides an assessment and planning process. In the assessment phase, a household survey is conducted to learn about community behavior related to key maternal and child health issues. Repeated surveys can be used to monitor the effect interventions aimed at behavior change.
Key Indicators
The process begins with a list of 16 emphasis or key behaviors which have been proven to decrease disease and death during childhood. The list of emphasis behaviors are shown in Table 1.
Table 1: Emphasis Behaviors
REPRODUCTIVE HEALTH PRACTICES: Women of reproductive age need to practice family planning and seek antenatal care when they are pregnant
1. For all women of reproductive age, delay the first pregnancy, practice birth spacing and limit family size
2. For all pregnant women, seek antenatal care at least two times during the pregnancy
3. For all pregnant women, take iron tablets.
INFANT AND CHILD FEEDING PRACTICES: Mothers need to give age-appropriate foods and fluids.
4. Breastfeed exclusively for about six months.
5. From about six months, provide appropriate complementary feeding and continue breastfeeding until 24 months
IMMUNIZATION PRACTICES: Infants need to receive a full course of vaccinations; women of childbearing age need to receive an appropriate course of tetanus vaccinations.
6. Take infant for measles immunization as soon as possible after the age of nine months.
7. Take infant for immunization even when he or she is sick. Allow sick infant to be immunized during visit for curative care.
8. For pregnant women and women of childbearing age, seek tetanus toxoid vaccine at every opportunity.
HOME HEALTH PRACTICES: Caretakers need to implement appropriate behaviors to prevent childhood illnesses and to treat them when they do occur.
Prevention
9. Use and maintain insecticide-treated bednets.
10. Wash hands with soap at appropriate times.
11. For all infants and children over six months, consume enough vitamin A to prevent vitamin A deficiency
12. For all families, use iodized salt.
Treatment
13. Continue feeding and increase fluids during illness; increase feeding after illness.
14. Mix and administer ORS, or appropriate home-available fluid, correctly.
15. Administer treatment and medications according to instruction (amount and duration).
CARE-SEEKING PRACTICES: Caretakers need to recognize a sick infant or child and need to know when to take the infant or child to a health worker or health facility.
16. Seek appropriate care when infant or child is recognized as being sick (i.e., looks unwell, not playing, not eating or drinking, lethargic or change in consciousness, vomiting frequently, high fever, fast or difficult breathing).
Research Design
Standard protocol:
The methodology combines PLA methods with a structured household survey and is conducted
over eight to ten days in each community. There are four phases:
Phase 1: Identifying Partners and Building Partnerships emphasizes the establishment of working relationships between the health staff and community team members. The health staff are introduced to the community through a public meeting. The community learns that the team is there to listen to them when they work together to draw a map of the community and list the health priorities.
Phase 2: Selecting the Emphasis Behaviors involves the use of a simple household survey which collects information on the key child health behaviors in a sample of households. The team then tabulates the data by hand. The behaviors shown to be at unacceptable levels by the survey are ranked by groups of men and women according to the importance of the behavior and the feasibility of changing them. Based on the community ranking, three to five priority behaviors are selected.
Phase 3: Exploring Reasons for the Behaviors involves the use of a variety of participatory research techniques, including semi-structured interviews, seasonal calendars, and matrix ranking, to explore the reasons behind the practices relating to the selected behaviors. For each behavior, the planning process uses a list of suggested topics and methods for increasing understanding of each behavior.
Phase 4: Developing Intervention Strategies involves review of the reasons respondents gave for failing to practice emphasis behaviors correctly. Both health staff and community members suggest intervention strategies. During a public meeting, the group develops an action plan to execute the strategies. The action plan includes an identification of resource needs and allocation of responsibilities.
Lessons from experience:
BASICS field tested this tool in Ethiopia and Zambia. In Ethiopia, the process was conducted in five districts in the Southern Nations and Nationalities People's Region (SNNPR) region. Ministry of Health staff from the regional level, four zones, and five districts were trained in the methodology for one week. The group then broke into five teams and spent eight to ten days completing the four phases in selected communities in five districts. The size of the communities ranged from 726 to 1187 households. At the end of the fieldwork, the group came together to develop detailed implementation plans and identify next steps.
In Zambia, the process involved the training of Ministry of Health staff (two weeks) and seven to eight days fieldwork in two communities. The survey included 65 households in Chipata district, Eastern Province. Fourteen people were trained including health staff from the national level, three districts in the Eastern Province, and staff from one health facility. Communities and health staff were encouraged to develop action plans that were feasible to implement with existing resources and structures. In general, the activities focused on the household (the knowledge and behavior of caretakers), the broader community (support required to sustain or enable household behaviors such as the availability of soap or community health workers) and the health facility (health worker knowledge and practice, the availability of medications).
The strategies developed by communities in both Ethiopia and Zambia had a number of similarities. Community members were often not able to secure vaccination or antenatal services. Thus, it was proposed that services be integrated to avoid missed opportunities (e.g., checking vaccination status of mothers and children during visits for curative care). Improving the counseling and health education skills of health workers on several key primary health care topics was considered very important. Within communities, improved community organization and participation was sited for supporting household level behavior change. It was proposed that community-based health workers and community groups be encouraged to conduct health education and motivate community members to seek services. Most communities wanted to involve existing community groups such as churches, mosques, and women's associations, and schools in health work. For example, some women said that their older children learned in school to remind their mothers to take their infants for immunizations. Some community members expressed a need to develop new groups such as health and nutrition groups.
The need for incentives for community health workers was raised in all communities and considered essential to sustain performance. Community groups discussed the development of revolving drug funds, or central community funds for supporting community health workers, as well as non-monetary incentives such as regular training, and the provision of farming assistance for community health workers and their families.
Limitations: See Table 2
| Table 2: The Community Assessment and Planning Process | |
| Does Not ... | Does ... |
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References
Battacharyya K, and Murray J., Community Assessment and Planning for Maternal and Child Health Programs. BASICS Technical Report. 1998.
Battacharyya K, Community Demand Study for the Essential Services for Health in Ethiopia Project. BASICS Technical Report. 1997.
Battacharyya K, and Murray J., Teaching Health Workers to Plan with Communities in Ethiopia and Zambia Draft Paper. BASICS. 1998.
1. For a complete discussion of the emphasis behaviors including the technical justification for their selection, see Emphasis Behaviors in Maternal and Child Health: Focusing on Caretaker Behaviors to develop Maternal and Child Health Programs in Communities, BASICS Technical Report, 1997.
Contact Person
Karabi Bhattacharyya
BASICS Project
1600 Wilson Blvd.
Arlington, VA 22209
703-312-6800